Obstetrician's attitudes about delivery through cesarean section: A study in hospitals at Mexico City

Paras, Andrea; Sosa, Salvador Espino y; Betancourt, Lidia; Tena, Carolina Zepeda; Gaytán, David Alejandro Cabrera; Nieto, Leopoldo; Alvarado, Gloria; Cevantes, M. López; Arenas, Luis Durán

doi:10.1016/j.rprh.2018.03.012

Cited by 11 publications

(8 citation statements)

References 30 publications

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“…Despite these efforts, implementation of these recommendations has faced challenges and high rates persist as reported here and previously [53–55]. Contributing factors may be the lack of training of health professionals, resistance to change and maintenance of practices not based on evidence, a perception of CD as harmless, quick and effective by pregnant women and physicians [56, 57]. Increased demand of CD by women from poor families, following trends documented in rich people, have also been reported [52].…”

Section: Discussionmentioning

confidence: 96%

Are overweight and obesity associated with increased risk of cesarean delivery in Mexico? A cross-sectional study from the National Survey of Health and Nutrition

Brenes-Monge

Saavedra-Avendano

Alcalde‐Rabanal

et al. 2019

BMC Pregnancy Childbirth

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Background In Mexico, obesity is a major public health problem; 71% of adults are overweight or obese. The proportion of deliveries by cesarean is also very high (45%). Women of reproductive age with overweight or obesity may be at higher risk of cesarean. Methods We conducted a cross-sectional study to test the association between overweight and obesity (using body mass index, BMI) and cesarean delivery in Mexico using data from the 2012 National Survey of Health and Nutrition (ENSANUT). Our sample included women of reproductive age at the time of survey who reported a live birth between 2006 and 2012. We used bivariate statistics and a multivariate logistic regression model to test the association between measured BMI and self-reported cesarean delivery. We included individual, clinical, and household level confounders and used survey weights to produce population estimates. Results Our sample consisted of 4,570 women (population N = 7,447,541). Overall, 44% of the women reported a cesarean at last delivery. We found differences in the proportion of cesarean delivery by BMI group (normal = 39%; 95% CI [35–43]; overweight = 42%; 95% CI [38–45]; obesity = 52%; 95% CI [48–57]; p < 0.001). In multivariable models controlling for socio-demographic and clinical characteristics, we found a strong and independent association between obesity and cesarean delivery among multiparous women, compared with multiparous women with normal BMI (obesity aOR: 1.60; 95% CI [1.21–2.12]). Conclusions We provide new evidence about the proportion of women with overweight and obesity who deliver in Mexico. Multiparous women with obesity are at higher risk of cesarean delivery in Mexico than multiparous women with normal body mass index. Given the high prevalence of both obesity and cesarean delivery in Mexico, this relationship is salient for women, health care providers, and the health system. Efforts to reduce the cesarean deliveries rate need to take the obesity epidemic into account. Electronic supplementary material The online version of this article (10.1186/s12884-019-2393-5) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 96%

Are overweight and obesity associated with increased risk of cesarean delivery in Mexico? A cross-sectional study from the National Survey of Health and Nutrition

Brenes-Monge

Saavedra-Avendano

Alcalde‐Rabanal

et al. 2019

BMC Pregnancy Childbirth

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“…Clinicians, often not being in a position to explain their individual clinical circumstances, described increasing concerns about the power of social media and its negative impact on their short-term and long-term practice that resonate with other literature [ 16 ]. Obstetric care providers’ preferences and attitudes, and a belief that CS is safer than vaginal births despite ongoing debate surrounding inappropriate CSs, are key factors influencing their preference and decision to perform CSs [ 49 , 59 ]. There were variations in practice among clinicians.…”

Section: Discussionmentioning

confidence: 99%

Clinicians’ views of factors influencing decision-making for CS for first-time mothers—A qualitative descriptive study

2022

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Clinicians’ perspectives of the reasons for performing caesarean section (CS) are fundamental to deepening knowledge and understanding of factors influencing decision-making for CS. The aim of this study was to explore midwives’ and obstetricians’ views of factors influencing decision-making for CS for first-time mothers. A qualitative descriptive study with semi-structured one-to-one audio-recorded interviews was used to gather data from clinicians (15 midwives and 20 senior obstetricians). Following research ethics committee approval, clinicians, who were directly involved in the decision-making process for CS during the period of data collection, were purposively selected from three maternity units in the Republic of Ireland between June 2016 to July 2017. The interviews were transcribed verbatim and analysed thematically. Three interrelated themes with several subthemes reflective of clinicians’ views and experiences emerged following data analysis. These were: ‘A fear factor’ describing clinicians’ fear of adverse outcomes and subsequent litigation, ‘Personal preferences versus a threshold–clinician driven factors emphasising the influence of clinicians’ personal beliefs, and ‘Standardised versus individualised care–a system perspective’ explaining the effects of, or lack of, organisational policy and its direct and indirect impact on the decision-making process. Findings show that decisions to perform a CS are, on occasion, based on clinicians’ personal beliefs and interpretation, similar to findings from other published literature. Consideration of broader issues related to organisational, socio-cultural and political context is essential when seeking solutions to the rising CS rates. The findings will enable clinicians to reflect on their day-to-day practice, in order to look for modifiable factors that influence their decision-making, and help women understand the multitude of factors that can lead to a decision to perform a CS. Findings will also contribute to the development of the ‘next step action’ and assist in devising future intervention studies to reduce any unnecessary CSs.

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“…Older age and more work experience lead to a positive attitude toward the C-section at the request of the mother in pregnant women who are afraid of vaginal delivery, and female gynecologists have a more positive attitude toward the C-section, as requested by the mother. (31,32) Clinical and medical interventions…”

Section: Attitude Of Service Providers Toward the Choice Of Delivery Typementioning

confidence: 99%

Assessment of Strategies for the Reduction of Cesarean Section Rate in Iranian and Foreign Studies: A Narrative Review

Moghadam

Alijani

Afrakoti

et al. 2020

International Journal of Women’s Health and Reproduction Scienc

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Objectives: This study was conducted aiming at exploring strategies for reducing cesarean section (C-section) in Iranian and foreign studies. Materials and Methods: The present study was carried out using a matrix approach and searching keywords including "Cesarean", "Effective Intervention", and "Cesarean Section Reduction Strategy" to find studies (2000-2019) in databases such as PubMed, SID, Science Direct, Google Scholar, and WHO. Results: CS reduction strategies were classified into 3 categories of psychological, clinical, and structural-policy interventions. The first category supports women throughout labor and childbirth by the midwife, doula, coping skills with fear and pain of labor, changes in the attitudes of service providers and pregnant women. Clinical interventions include vaginal birth after CS, vaginal breech delivery, external cephalic version (ECV) for breech presentation, encouragement of service providers into intermittent auscultation for the fetal heart rate instead of continuous electronic fetal monitoring (EFM), and training of service providers, pregnant woman, and her family. The last category encompassed managing insurance and financial services, receiving one-to-one care and midwifery care throughout active labor, and updating policy of labor induction in post-term pregnancy, as well as women’s admission policy with cervical dilatation of more than 4 cm with regular uterine contractions, active team care in labor, and auditing and feedback. Conclusions: It seems that multi-dimensional interventions are required to reduce the CS rate. Concerning some of the strategies (e.g., ECV), it is suggested that further research should be performed by addressing the limitations and drawbacks of previous studies before applying clinical procedures due to contradictory results.

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Obstetrician's attitudes about delivery through cesarean section: A study in hospitals at Mexico City

Cited by 11 publications

References 30 publications

Are overweight and obesity associated with increased risk of cesarean delivery in Mexico? A cross-sectional study from the National Survey of Health and Nutrition

Are overweight and obesity associated with increased risk of cesarean delivery in Mexico? A cross-sectional study from the National Survey of Health and Nutrition

Clinicians’ views of factors influencing decision-making for CS for first-time mothers—A qualitative descriptive study

Assessment of Strategies for the Reduction of Cesarean Section Rate in Iranian and Foreign Studies: A Narrative Review

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