Caesarean delivery accounts for approximately one in four births both in Australia and on a global level. Examination of the experience of caesarean delivery is limited, although as caesarean delivery rates are increasing, a practical understanding of the constructs surrounding surgical birth needs to be gained. This review aims to present an ovetview of the current literature exploring the mother's experience of caesarean delivery. The different modes of medically necessary caesarean delivery, both unplanned and planned are defined. Societal views of caesarean birth as an easier and convenient mode of delivery in comparison to vaginal birth are described and it is suggested that this perception is unjust and misrepresentative of the actual experience. The impact of delivery on appraisal of childbirth satisfaction and the incongruence between personal expectations and delivery are also explored. Psychological adjustment in the postpartum is an area of incongruent literature, although qualitative studies are defining the links between caesarean delivery and high rates of anxiety and fear. The association between caesarean delivery and postnatal depression and post traumatic stress disorder is also presented. The importance of the utilisation of qualitative and interactive research methodology to explore the experience of caesarean birth and the practical implications for psychological adjustment after caesarean delivery are discussed. Author: Michelle Cotterell SupeJVisors : Lis Pike Paul Murphy Submitted: August 2004 Experiences of a caesarean 3 Exploring Women's Experiences of a Medically Necessary Caesarean Introduction The experience of caesarean birth is an area of limited research in Australia. This is surprising as Australian has one of the highest rates of caesarean delivery on a global scale, with approximately one in four infants born after surgical intervention (Walker, Turnbull & Wilkinson, 2004). The psychological adjustment of becoming a mother is compromised by the juxtaposition of the surgical experience and the exuberance felt with the birth of the infant. This review aims to define the different modes of medically necessary caesarean delivery and explore current literature that describes societal expectations of childbirth (Nelson, 2003; ·walker, Turnbull &Wilkinson, 2004), personal constructs of childbirth satisfaction (Goodman, Mackey & Tavakoli, 2004), and psychological adjustment after delivery (Affonso & Stichler, 1981). Womens personal reaction to a caesarean birth are different depending on whether the delivery is planned or unplanned (Durik, Hyde & Clark, 2000). Personal apperceive has found to differ between primipara (first birth) or multiparous (subsequent births) experience (Gamble & Greedy, 2001 ). The relationship betv.'een caesarean delivery and postnatal depression (Koo, Lynch & Cooper, 2003), and post traumatic stress disorder (Reynolds, 1997) will also be addressed. Defining Terminology Caesarean deliveries occur for a multitude of reasons, originating from maternal or foetal risk factors. Foetal complications include heartbeat fluctuations, very low birthweight, multiple birth and breech presentation (Australian Institute of Health and Welfare [AIHW], 2000). Maternal complications include pre-eclampsia, failure to progress during labour, placenta praevia, placenta abrupta, cephalopelvic disproportion and cord presentation (AIHW. 2000). Prenatal psychological concerns such as extreme anxiety and fear of childbirth (Ryding, Wijma, Wijma & Rydhstrom, 1998), previous Experiences of a caesarean 4 traumatic birth (Gamble & Creedy, 2001) and mental health issues (Kendell, Chalmers & Platz, 1987) may indicate that a caesarean delivery is a safer birth option (Kirby & Hanlon-Lundberg, 1999) than vaginal delivecy. The caesarean that is essential for the medical and/or psychological well being of the mother/infant dyad is tenned the 'medically necessary caesarean' (Schindl eta!., 2003). There are two forms of medically necessary caesarean deliveries, unplanned and planned. An unplanned caesarean delivery is usually an emergency, where the immediate delivery of the infant is detennined by obstetric intervention. Planned medically necessary delivery occurs ifthere are foreseeable complications with delivery such as previous birth experiences or prenatal medic~J conditions. The use of the tenninology 'planned medically necessary' caesarean over the common term 'elective' caesarean was chosen to emphasise that a caesarean delivery for medical necessity does not reflect elective wishes from the mother. Caesarean delivery, chosen by maternal request with no medical or psychological determination, is more definitive of the tenn 'elective' caesarean. Reasons for chm;en surgical birth may include work commitments or child minding options (Eden, Hashima, Osterweil, Nygren & Guise, 2004; Kirby & Hanlon-Lundberg, 1999). This mode of caesarean delivecy will not be explored in~depth in this review, which focuses on medically necessary caesarean delivery. Rates of Caesarean Delivery Recent Australian statistics indicate that approximately 23.3% of all live births are by caesarean delivery (AIHW, 2000). Western Australian statistics for caesarean birth echo this figure of one in four births (AlliW, 2000; "Under the Knife", 2003). This is comparative with other western countries such as the United States and United Kingdom with rates of26% and 20% respectively (Walker, Turnbull & Wilkinson, 2004). Australian Experiences of a caesarean 5 statistics which separate the different modes of delivery, ie., emergency or elective do not distinguish between planned medically necessary caesarean delivery and caesareans performed on maternal request (AlHW, 2000). Thus, statistics that report that almost half of the caesarean deliveries in Western Australia and Australia are elective do not represent the figures for caesarean delivery planned for medical necessity. It has been reported that only 2 %of caesarean deliveries in the United Kingdom are elected without medical or psychological origin (Bushe, 2003), thus comparability of overall caesarean statistics could lead us to generalise that this figure may reflect Australian rates. Reasons for Jncreas;ng Rates of Caesarean Delivery Australian caesarean rates have risen by 35% since 1990 (Walker, Turnbull & Wilkinson, 2002). Possible reasons for this increase include the routine use of ultrasound and foetal monitoring such as cardio tocography (CTG) which measures foetal heart rate and uterine contractions. Therefore, it is possible to detennine early signs of foetal distress and prenatal complications in pregnancy or labour (Placek, Taffe! & Liss, 1987). Infants with very low birthweight (1000-1499 grams) have a greater chance of being born via caesarean delivery than vaginal delivery (AIHW, 2000). It has become common obstetric practice to deliver infants with breech presentation by caesarean as opposed to feet first delivery (AIHW, 2000; Placek et al., 1987). Rising maternal age may also affect the increasing caesarean rate, as age has been associated with birth complications (Qublan, Alghoweri, AI-Taani, Abu-Khait, Abu-Salem & Merhej, 2002). Threat oflegal action has seen obstetricians have a more precautionary outlook in complicated deliveries, thus the aphorism when in doubt, cut it out" (p. 259, Kirby & Hanlon-Lundberg, 1999). Higher rates of caesarean delivery parallel the decline in neonatal and perinatal death rates (AIHW, 2000). Experiences of a caesarean 6 The acknowledgment that psychological concerns can predispose or contribute to complications during childbirth may have also added to the increase in caesarean rates. Ryding, Wijma,Wijma and Rydstrom (1998) investigated the association between extreme fear of childbirth in the third trimester and delivery by caesarean. Fear of childbirth was defined by Ryding et al. 1998 as high levels of anxiety and minimal ability to cope with stress. Results suggest fear of childbirth is an increased risk factor for an emergency caesarean delivery. Previous sexual abuse has also been associated with anxiety and distress in labour resulting in childbirth complications (Rhodes & Hutchinson, 1994). The understanding that unplanned caesarean delivery is more traumatic physically, emotionally, and psychologically (Schindl et al., 2003) than planned caesarean delivery (Creedy, Shoctet & Horsfall, 2000), suggests that preparing the mother for caesarean delivery is advisable ifthere are any factors to suggest that a caesarean delivery may be imminent. Expectations of Birth During the prenatal period women develop preconceived expectations of the idealised birth and delivery experience. Expectations for birth come from personal experiences, societal and familial views and are modemted by self-perception (Nelson, 2003; Smith, 1999). When expectations are not fulfilled the delivery experience will be appraised as negative and can effect the way one views ones transition to motherhood (Mercer & Marut, 1981 ). Social Perceptions Although more women are experiencing caesarean delivery than ever before, societal perception of a surgical birth reflect archaic and unjust representations. The journey to motherhood is often portrayed in society as a rite of passage with vaginal delivery worn as a badge and measure of true ability as a mother (Nelson, 2003; Rice & Experiences of a caesarean 7 Naksook, 1998). The caesarean mother is seen as cheating her physiological prophecy and taking the easy delivery mode. Nelson (2003, p. 25) eloquently describes populist cultural mythology of the caesarean mother as 11 frightening and repellent" to other mothers. Higher rates of caesarean delivery in private practice than public hospitals (Roberts, Tracey & Peat, 2000) have been sensationalised by tabloid representations of a too posh to push attitude exemplifYing that caesarean must be simply to avoid the physicality of labour(Barley, Aylin, Bo

This paper examines the theoretical linkage between social capital and sense of community through research studies within four contextual areas. Social capital (SC) can be conceptualized as all the interactions between individuals in a community, and has been examined in various groups and communities. Sense of community (SoC) is a psychological construct that we argue is a correlate of social capital. Sense of community reflects the feelings of attachment and belonging that an individual has towards a community. Through qualitative and quantitative research carried out across the lifespan in four communities in Western Australia (i.e., Perth community, adolescent Jewish community, urban and rural communities, and primary school community), this paper utilizes SoC as a framework for investigating ways in which SC may be realized in communities. The significance of this paper highlights the practical application of increasing SC within communities through targeting SoC within individuals.

This article describes a study that examined the competence and self-esteem of 136 Australian single-parent primary school-aged children growing up in different single-parent residency arrangements. It compared these children with a matched sample of two-parent children. Child competence was assessed across a range of domains (academic, physical, social, behavioural and everyday life skills). The analysis revealed that overall, the single-parent children were not significantly different from the two-parent children in competence levels and self-esteem. There were, however, subtle differences in performance on the measures between and within each parent residency group linked to the gender of the child and the gender of the residential parent.