Caesarean section on request: a comparison of obstetricians' attitudes in eight European countries (original) (raw)
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In recent decades, the rate of caesarean deliveries has increased worldwide. The reasons for this trend are still largely misunderstood and controversial among researchers. The decision often depends on the obstetrician, his beliefs and experience, the characteristics of the patients, the hospital environment and its internal protocols, the increasing use of induction of labor, the medico-legal implications, and, finally, the mother's ability to request delivery by caesarean section without medical indication. This review aims to describe the reasons behind the increasing demand for caesarean sections by patients (CDMR) and strategies aimed at reducing caesarean section rates and educating women about the risks and benefits of CS.
BJOG : an international journal of obstetrics and gynaecology, 2018
To describe obstetrical providers' delivery preferences and attitudes toward caesarean section without medical indication, including on maternal request, and to examine the association between provider characteristics and preferences/attitudes. Cross-sectional study. Two public and two private hospitals in Argentina. Obstetrician-gynecologists and midwives who provide prenatal care and/or labor/delivery services. Providers in hospitals with at least 1,000 births per year completed a self-administered, anonymous survey. Provider delivery preference for low-risk women, perception of women's preferred delivery method, support for a woman's right to choose her delivery method and willingness to perform caesarean section on maternal request. One hundred and sixty-eight providers participated (89.8% coverage rate). Providers (93.2%) preferred a VD for their patients in the absence of a medical indication for caesarean section. While 74.4% of providers supported their patient&#...
A Critique of the Literature on Women’s Request for Cesarean Section
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Background: The influence of women's birth preferences on the rising cesarean section rates is uncertain and possibly changing. This review of publications relating to women's request for cesarean delivery explores assumptions related to the social, cultural, and politicaleconomic contexts of maternity care and decision making. Method: A search of major databases was undertaken using the following terms: ''c(a)esarean sectionSeventeen papers examining women's preferred type of birth were retrieved. Results: No studies systematically examined information provided to women by health professionals to inform their decision. Some studies did not adequately acknowledge the influence of obstetric and psychological factors in relation to women's request for a cesarean section. Other potential influences were poorly addressed, including whether or not the doctor advised a vaginal birth, women's access to midwifery care in pregnancy, information provision, quality of care, and cultural issues. Discussion: The psychosocial context of obstetric care reveals a power imbalance in favor of physicians. Research into decision making about cesarean section that does not account for the way care is offered, observe interactions between women and practitioners, and analyze the context of care should be interpreted with caution. (BIRTH 34:4 December 2007)
Elective Cesarean Section and Decision Making: A Critical Review of the Literature
Birth, 2007
Background: The cesarean section rate continues to rise in many countries with routine access to medical services, yet this increase is not associated with improvement in perinatal mortality or morbidity. A large number of commentaries in the medical literature and media suggest that consumer demand contributes significantly to the continued rise of births by cesarean section internationally. The objective of this article was to critically review the research literature concerning women's preference or request for elective cesarean section published since that critiqued by Gamble and Creedy in 2000. Methods: A search of key databases using a range of search terms produced over 200 articles, of which 80 were potentially relevant. Of these, 38 were research-based articles and 40 were opinion-based articles. A total of 17 articles fitted the criteria for review. A range of methodologies was used, with varying quality, making meta-analysis of findings inappropriate, and simple summaries of results difficult to produce. Results: The range and quality of studies had increased since 2001, reflecting continuing concern. Women's preference for cesarean section varied from 0.3 to 14 percent; however, only 3 studies looked directly at this preference in the absence of clinical indications. Women's preference for a cesarean section related to psychological factors, perceptions of safety, or in some countries, was influenced by cultural or social factors. Conclusions:
Women's Knowledge, Perceptions, and Potential Demand Towards Caesarean Section
2011
In today’s situation when the access to obstetric care is growing day by day there has been a concern over the rising caesarean rates over the world. A cross-sectional study was undertaken with an objective to determine the level of knowledge, attitudes, and perceptions about CS among pregnant women. All pregnant women, attending antenatal clinic, were interviewed with a structured questionnaire. Data analysis was done by using Epi info software. Of the total 247 women, participated in this study, the potential demand for CS was low and majority of women preferred vaginal delivery (91.5%). The majority of women (65.1%) were found to have very little knowledge. Overall, women preferring caesarean birth were multiparous (P<0.05), and were more likely to have had previous caesarean delivery (P<0.001), but there were otherwise no differences in age, parity, income, or education. However, most are still in favor of CS if it is necessary to protect their health or that of their infa...
Acta Obstetricia et Gynecologica Scandinavica, 2004
Objective. To assess Danish obstetricians' and gynecologists' personal preference and general attitude towards elective cesarean section on maternal request in uncomplicated single cephalic pregnancies at term. Design. Nation-wide anonymous postal questionnaire. Population. Four hundred and fifty-five obstetricians and gynecologists identified in the records of the Danish Society of Obstetrics and Gynecology from January 2000. Main outcome measures. Personal preference on the mode of delivery and general attitude towards elective cesarean section on maternal request in an uncomplicated single cephalic pregnancies at term. Results. Of Danish specialists in obstetrics and gynecology, 1.1% would prefer an elective cesarean section in an uncomplicated pregnancy at 37 weeks of gestation with fetal weight estimation of 3.0 kg. This rose to 22.5% when the fetal weight estimation was 4.5 kg at 37 weeks. The main reasons given for preferring abdominal deliveries was the risk to the fetus, risks of perineal injury, and urinary and anal incontinence.