Cesarean effects on adolescents’ birth experiences: counterfactual analysis

Abstract

Introduction The birth experience of adolescents is understudied even though they are a particularly vulnerable population to experience a negative birth event, given that they exhibit many known risk factors. Objective To ascertain whether a cesarean birth mediates the impact of infant complications on the birth experience of adolescent mothers. Methods Using a secondary analysis of data collected from 303 postpartum adolescents previously evaluated for depression and post-traumatic stress, we employed counterfactual causal analysis to determine if delivery type mediated the birth experience at different levels of depression. Noted limitations pertain to methodological assumptions and computational feasibility as well as potential sample bias. Results We found that the mediating effect of delivery mode depended on the adolescent’s depression level as well as on the specific operationalization of the birth experience. At low levels of depression, the odds of a negative birth appraisal were reduced by around 30% when operationalized as a single item subjective rating. In contrast, at high levels of depression, the odds of a negative birth experience increased by 80% when operationalized as an Impact of Event Scale (IES) subconstruct. Conclusion Depression level plays a pivotal role in moderating how delivery mode mediates the birth experience. The direction of impact also depends on how the birth experience is operationalized.

Improved survival of non-small cell lung cancer patients after introducing patient navigation: A retrospective cohort study with propensity score weighted historic control

“…Counterfactual impact evaluation is a valuable tool for comparing the outcomes of interest in subjects exposed to a program to outcomes that would have been achieved if the intervention had not been implemented [ 69 ]. In studies without randomization, the counterfactual analysis is frequently focusing on simulated outcomes that could have occurred under different conditions, e.g., without exposure to the investigated program [ 70 , 71 ]. In our study, the estimated hazard rate of intervention was applied in the counterfactual analysis where all baseline characteristics of the study patients showed identical patterns in the two compared cohorts, except for the assumption that counterfactual cohort patients did not receive the intervention.…”