The (Un)informed Patient: A Comparative Study of Anxiety and Sense of Control in Primary and Secondary Caesarean Sections

Objective: Unplanned Caesarean section (CS) constitutes a very stressful event, and is associated with traumatic birth experience. Especially feelings of helplessness, poor information and communication are reported as distressing factors in unplanned Caesarean birth. Addressing these stressors by offering timely patient education and counselling, might be a way to improve sense of control and reduce anxiety. This study compared anxiety and sense of control between women who had a planned caesarean section (PCS) and patients who had an unplanned/secondary caesarean section (SCS).

Methods: The sample consisted of 129 women (PCS=66; SCS=63). It was hypothesized that the PCS group benefitted more from patient education than the SCS group leading to lower levels of anxiety and a higher sense of control. Possible confounding factors were controlled for (example, previous child birth experiences and the patient’s locus of control). Anxiety and sense of control were measured by Visual Analogue Scales intraoperatively and one day postoperatively. The Control Preferences Scale and the Multidimensional Health Locus of Control assessed the discrepancy between desired - perceived control and the locus of control, respectively. By means of a checklist it was registered whether subjects had an adequate comprehension of the patient education provided. Multiple regression analyses were used to analyze the data.

Results: Intraoperative sense of control during SCS was scored significantly lower as compared to PCS. A higher sense of control was associated with significantly lower anxiety scores in both groups. Furthermore, a more internal locus of control was related to a greater discrepancy between desired and perceived control. Additional patient education in the PCS condition seemed to increase the sense of control.

Conclusion: Patient education about the Caesarean procedure might benefit the psychological well-being of the mothers as it lowers anxiety scores indirectly via a heightened sense of control.

Author(s): Marjan Nijkamp, Alice Oldenbroek, Jeroen Dijkstra and Esther Bakker

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