Contemplating Our Maternity Care Crisis in the United States: Reflections of an Obstetrician Anesthesiologist

Pryde, Peter G.

doi:10.1213/ane.0000000000004026

Cited by 3 publications

(2 citation statements)

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“…The 26.6% in public women's hospitals, and 8.3% in private hospitals with > 90% of respondents working at Level II (municipal) or III (tertiary) hospitals (Level III is the highest level in the Chinese ranking system). The general results above are the same as the first portion of our survey reports [15].…”

Section: Resultsmentioning

confidence: 99%

“…These choices reflect the demographic of physicians In China where there are currently only 5 anesthesiologists per 100,000 people compared to 20 per 100,000 in the US [23][24][25]. Obstetric anesthesiologists playing a vital role in parturient safety [26], however, the specialty does not officially exist in China. Lack of either anesthesiologists or obstetric anesthesiologists in low/middle income countries including China could be one of the contributors to the higher maternal mortality rate compared to other countries [27].…”

Section: Plos Onementioning

confidence: 99%

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Why is the labor epidural rate low and cesarean delivery rate high? A survey of Chinese perinatal care providers

et al. 2021

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Objective China has a high cesarean delivery (CD) and low labor epidural analgesia (LEA) rate. This online survey was conducted to explore the reasons behind this phenomenon and potential solutions. Methods A voluntary, anonymous survey was distributed via both WeChat and professional websites for 4 months amongst groups of Chinese perinatal professionals. Data was collected and analyzed using a Chi-square test and presented as percentages of respondents. Results 1412 respondents were recorded (43% anesthesiologists, 35% obstetricians, 15.5% midwives or labor and delivery nurses, and 6.5% others), and 1320 respondents were care providers. It was found that 82.7% (1092/1320) of the provider respondents used CD per patient request in fear of lawsuits or yinao/yibao and 63.4% (837/1320) used CD for respecting superstitious culture. The number one reason (noted by 60.2% (795/1320) of all the three specialties) for low LEA use was lack of anesthesia manpower without statistical difference among specialties. The most recommended solution was increasing the anesthesia workforce, proposed by 79.8% (1053/1320) of the three specialties. However, the top solution provided by the two non-anesthesia specialties is different from the one proposed by anesthesiologists. The later (83%, 504/606) suggested increasing the incentive to provide the service is more effective. The answers to questions related to medical knowledge about CD and LEA, and unwillingness of anesthesiologists, parturients and their family members to LEA were similar for the most part, while the opinions regarding low LEA use related to poor experiences and unwillingness of obstetricians and hospital administrators were significantly divided among the three specialties. In the providers’ point of view, the unwillingness to LEA from parturient’s family members was the most salient (26.1%, 345/1320), which is more than all care providers, hospital administrators, and parturients themselves (16.8%, 222/1320). Conclusion The reasons for high CD rate and low LEA use are multifactorial. The sociological issues (fear of yinao/yibao and superstitious culture) were the top two contributing factors for the high CD rate in China, while lack of anesthesia manpower was the top response for the low LEA use, which contributes to its being the most recommended solution overall from the three specialties. An incentive approach to providers is a short-term solution while training more perinatal care providers (especially among anesthesiologists and midwives), improving billing systems, and reforming legal systems are 3 systemic approaches to tackling this problem in the long-term.

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Section: Resultsmentioning

confidence: 99%