A Comparison Between Swedish Midwives and Obstetricians &amp; Gynecologists Opinions on Cesarean Section

Josefsson, Ann; Gunnervik, Christina; Sydsjö, Adam; Sydsjö, Gunilla

doi:10.1007/s10995-010-0630-7

Cited by 13 publications

(18 citation statements)

References 13 publications

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“…Increased demand for a repeat CS (n = 15, 45.7%) and fear of litigation (n = 10, 26.8%) were also reported by Kenyan obstetricians as two reasons for the declining trend of VBAC [ 46 ]. More obstetricians than midwives in a Swedish study had a positive attitude towards maternal request for elective CS [ 43 ]. Over half of the obstetricians in a US study (n = 322, 54.6%) [ 16 ], and over one-third of the obstetricians and gynaecologists in studies in Turkey (n = 158, 40.8%) [ 15 ] and Denmark (n = 137, 37.6%) [ 31 ] believed that women had a right to choose a CS, and agreed to perform one following discussion of the risks and consequences.…”

Section: Thematic Analysis and Meta-synthesismentioning

confidence: 99%

Clinicians’ views of factors influencing decision-making for caesarean section: A systematic review and metasynthesis of qualitative, quantitative and mixed methods studies

2018

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BackgroundCaesarean section rates are increasing worldwide and are a growing concern with limited explanation of the factors that influence the rising trend. Understanding obstetricians’ and midwives’ views can give insight to the problem. This systematic review aimed to offer insight and understanding, through aggregation, summary, synthesis and interpretation of findings from studies that report obstetricians’ and midwives’ views on the factors that influence the decision to perform caesarean section.MethodsThe electronic databases of PubMed (1958–2016), CINAHL (1988–2016), Maternity and Infant Care (1971–2016), PsycINFO (1980–2016) and Web of Science (1991–2016) were searched in September 2016. All quantitative, qualitative and mixed methods studies, published in English, whose aim was to explore obstetricians’ and/or midwives’ views of factors influencing decision-making for caesarean section were included. Papers were independently reviewed by two authors for selection by title, abstract and full text. Thomas et al’s 12 assessment criteria checklist (2003) was used to assess methodological quality of the included studies.ResultThe review included 34 studies: 19 quantitative, 14 qualitative, and one using mixed methods, involving 7785 obstetricians and 1197 midwives from 20 countries. Three main themes, each with several subthemes, emerged. Theme 1: “clinicians’ personal beliefs”–(‘Professional philosophies’; ‘beliefs in relation to women’s request for CS’; ‘ambiguous versus clear clinical reasons’); Theme 2: “health care systems”–(‘litigation’; ‘resources’; ‘private versus public/insurance/payments’; ‘guidelines and management policy’). Theme 3: “clinicians’ characteristics” (‘personal convenience’; ‘clinicians’ demographics’; ‘confidence and skills’).ConclusionThis systematic review and metasynthesis identified clinicians’ personal beliefs as a major factor that influenced the decision to perform caesarean section, further contributed by the influence of factors related to the health care system and clinicians’ characteristics. Obstetricians and midwives are directly involved in the decision to perform a caesarean section, hence their perspectives are vital in understanding various factors that have influence on decision-making for caesarean section. These results can help clinicians identify and acknowledge their role as crucial members in the decision-making process for caesarean section within their organisation, and to develop intervention studies to reduce caesarean section rates in future.

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Section: Thematic Analysis and Meta-synthesismentioning

confidence: 99%

Clinicians’ views of factors influencing decision-making for caesarean section: A systematic review and metasynthesis of qualitative, quantitative and mixed methods studies

2018

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“…Despite several studies that describe a lack of cooperation and professional disagreements among midwives and obstetricians on the decision-making process for CS [ 21 , 24 , 29 ], findings from these FGIs show that there is ‘a team approach’ with the midwifery and obstetric teams in these two sites that helps them maintain a low CS rate.…”

Section: Discussionmentioning

confidence: 82%

“…In this study, maternal request for CS because of fear of childbirth was regarded as rare among nulliparous women. While attitudes to maternal request for CS differ among midwives and obstetricians in other countries [ 23 , 24 ], in the absence of any medical indication, CS on maternal request is rarely an option in Sweden [ 11 ]. Clinicians in this study were clear and consistent about counselling women who request a CS.…”

Section: Discussionmentioning

confidence: 99%

Factors influencing decision-making for caesarean section in Sweden – a qualitative study

Panda

Daly

Begley

et al. 2018

BMC Pregnancy Childbirth

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BackgroundRising rates of caesarean section (CS) are a concern in many countries, yet Sweden has managed to maintain low CS rates. Exploring the multifactorial and complex reasons behind the rising trend in CS has become an important goal for health professionals. The aim of the study was to explore Swedish obstetricians’ and midwives’ perceptions of the factors influencing decision-making for CS in nulliparous women in Sweden.MethodsA qualitative design was chosen to gain in-depth understanding of the factors influencing the decision-making process for CS. Purposive sampling was used to select the participants. Four audio-recorded focus group interviews (FGIs), using an interview guide with open ended questions, were conducted with eleven midwives and five obstetricians from two selected Swedish maternity hospitals after obtaining written consent from each participant. Data were managed using NVivo© and thematically analysed. Ethical approval was granted by Trinity College Dublin.ResultsThe thematic analysis resulted in three main themes; ‘Belief in normal birth – a cultural perspective’; ‘Clarity and consistency – a system perspective’ and ‘Obstetrician makes the final decision, but...’, and each theme contained a number of subthemes. However, ‘Belief in normal birth’ emerged as the core central theme, overarching the other two themes.ConclusionFindings suggest that believing that normal birth offers women and babies the best possible outcome contributes to having and maintaining a low CS rate. Both midwives and obstetricians agreed that having a shared belief (in normal birth), a common goal (of achieving normal birth) and providing mainly midwife-led care within a ‘team approach’ helped them achieve their goal and keep their CS rate low.

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“…Midwives’ and obstetricians’ approaches to caring for the pregnant women are also affected by their personal attitudes, knowledge and cultural background and these all may affect their recommended choice of mode of delivery. Attitudes and knowledge of the obstetric risks, possible delivery complications, and mode of delivery in general vary between individuals in any group and even between different groups of professionals [ 15 - 17 ]. Thus it appears that even professionals may generalize, as shown by results from studies pointing that professionals generally believe that all women with FOC are delivered by elective CS [ 14 - 16 ].…”

Section: Discussionmentioning

confidence: 99%

Obstetric outcomes for nulliparous women who received routine individualized treatment for severe fear of childbirth - a retrospective case control study

Sydsjö

Bladh

Lilliecreutz

et al. 2014

BMC Pregnancy Childbirth

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BackgroundTo study pregnancy and delivery outcomes in nulliparous women with severe FOC (fear of childbirth), all of whom had received routine treatment for their FOC and to make comparisons with a healthy reference group of nulliparous women.To study the possible relationship between the number of FOC-treatment sessions and the delivery method.MethodsAll nulliparous women with a diagnose FOC who received routine treatment for FOC (n = 181) and a reference group of nulliparous women without FOC (n = 431) at a university and a county hospital in the south east region of Sweden were analysed. Data from antenatal and delivery medical records were used to study outcome.ResultsThe majority of women with severe FOC had a vaginal delivery. The incidence of elective CS was greater in the index group than in the reference group (p < 0.001). The total number of women with a planned CS in the index group was 35 (19.4%) and in the control group 14 (3.2%). Thus, on average five women per year received an elective CS during the study years due to severe FOC. The women in the index group who wished to have a CS were similar to the other women in the index group with reference to age, BMI, chronic disease but had been in in-patient care more often during their pregnancy than those who did not ask for CS (p = 0.009).ConclusionIn this study of women treated for severe FOC, the majority gave birth vaginally and no relationship was found between number of treatment sessions and mode of childbirth.

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A Comparison Between Swedish Midwives and Obstetricians & Gynecologists Opinions on Cesarean Section

Cited by 13 publications

References 13 publications

Clinicians’ views of factors influencing decision-making for caesarean section: A systematic review and metasynthesis of qualitative, quantitative and mixed methods studies

Clinicians’ views of factors influencing decision-making for caesarean section: A systematic review and metasynthesis of qualitative, quantitative and mixed methods studies

Factors influencing decision-making for caesarean section in Sweden – a qualitative study

Obstetric outcomes for nulliparous women who received routine individualized treatment for severe fear of childbirth - a retrospective case control study

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