Background/Aims: “Gentle” or “natural” cesarean sections are implemented to improve parental satisfaction. The objective of this study was to investigate whether there is a need for adopting such a gentle approach. Methods: We recruited those with low-risk pregnancies scheduled for elective cesarean delivery at term. Three questionnaires were administered to both partners: prior to delivery, 2-5 days after delivery, and 6 weeks postpartum. Questionnaires assessed the couple's expectations, fears, and satisfaction prior to and after cesarean section. Additionally, participants attended 2 structured interviews: one prior to delivery and one 6 weeks after delivery. Results: Fifteen couples underwent a “standard” cesarean section (group 1) and 6 underwent a “gentle” section (group 2). Overall, parental satisfaction with cesarean section was high. However, women in the standard group felt less involved in childbirth and both groups still preferred vaginal delivery in light of eventual future pregnancies. Participants in group 2 showed less fear of childbirth after delivery than prior to delivery. There were no differences in total questionnaire scores between groups or between mothers and partners. Conclusion: This study shows that there is room for improvement in satisfaction levels around cesarean section, even though satisfaction is generally high. A “gentle” cesarean section may help to achieve this.

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Background: About 0.8% of all newborns have a congenital heart defect (CHD), varying from simple to complex heart lesions. New technologies and the improvement of patient management yield that 90% of these patients reach adulthood. Then, new health-related issues may arise, such as obtaining life or health insurance. This study aims to review the current state-of-the-art about insurance for patients with CHD. Methods: The databases Medline, Cochrane and Cinahl were searched using these key terms: congenital heart defect, cardiovascular disease, life insurance, health insurance and insurability. Empirical studies and articles in English or Dutch were included. Expert opinions and articles published before 1985 were excluded. Using the snowball-method, the reference list of all articles was screened to identify additional literature. Initially, 24 articles were found but 21 articles did not meet the inclusion criteria. Hence, 3 articles were considered: two cross-sectional studies and one case-control study. The two cross-sectional studies sent a questionnaire describing 18 to 20 common CHD (varying from mild to severe) to 20 and 8 life insurance companies, respectively. The insurance companies were asked whether a subject with CHD was insurable at standard or higher rates, or was not insurable at all. In the case-control study, a structured questionnaire was given to patients with CHD and to healthy counterparts. Results. The two cross-sectional studies found that there was a high degree of agreement between the companies in (not) giving an insurance according to the severity of the disease. However, important differences were found. The first study found that, although children with small ventricular septal defects have an excellent prognosis, 57% of the insurance companies applied higher rates. The second study reported that subjects with mild or post-operative Ebstein's anomaly were uninsurable in half of the insurance companies. The case-control study revealed that patients with CHD are significantly more refused for life insurance at standard rates than their healthy counterparts. More specifically, 42% of the patients with CHD were refused a life insurance at standard rates, but 65% was accepted at higher rates. Only 38% of the insurance companies uses standardized guidelines. Conclusions. The use of standardized guidelines is not widely spread among insurance companies and leads to inconsistencies in granting insurances. Nurses should educate patients with CHD about the possible insurance-related difficulties. This is an indispensible issue in educational programmes for patients with CHD.

instrument by himself, and the nurse decides about the interventions in conversation with the patient. Evaluation of the guidance and psychosocial wellbeing happens later on when the patient fills in the screening instrument again. The result will be discussed with the patient.