Who Indicates Caesarean Section in Romania? A Cross-Sectional Survey in Tertiary Level Maternity on Childbirth Patients and Doctors' Profiles

Abstract

<jats:title>Abstract</jats:title> <jats:p><jats:italic>Background</jats:italic>. C-section rate in Romania is the second-highest in the European Union (44.1% in 2017)<jats:bold> </jats:bold>and the number of C-sections performed in the country increased by 32.1% between 2009 and 2017. We offer for the first time insights into the practice and perceptions of patients and doctors in Romania towards delivery mode and on health system particularities that lead to increased numbers of C-sections. The objectives are 1) to compare the preferred modes of birth among women 2) to draw a profile of patients in whose case the actual birth method is different from the preferred method, and 3) to outline a profile of doctors and patients based on the modes of delivery. <jats:italic>Methods</jats:italic>. We conduct a statistical analysis based on an observational, analytical, and cross-sectional survey on 117 singleton pregnant women more than 36 weeks in spontaneous labor in tertiary level maternity in Romania. Various statistical tests have been used to indicate statistical significance. <jats:italic>Results</jats:italic>. Our results show an increase of almost 58% in actual childbirth mode against preferred childbirth by C-sections, rather difficult to justify based only on medical emergencies. There are 22 patients with non-concordant C-section indications between preferred and actual mode of birth, 7 of them (31.8%) preferred natural birth and 15 (68.2%) preferred C-section. Scarred uterus is the most frequent medical indication for C-section (30.7%). Overall, birth and birth pain assessment correlates to preferred and actual delivery modes, but respondents distinguish clearly between birth pain alone and their overall birth experience. The profiles of patients with concordant and non-concordant delivery modes are different, and indicate a statistically significant difference between the preference for delivery and actual birth method. Patients who preferred vaginal birth, but gave birth by C-section, are mature and more educated women, in the middle to the high-income category, mostly attended by consultant doctors and specialists. Doctors’ profiles show that specialists and consultants attend the largest share of non-concordant births, while residents and young senior doctors attend mostly vaginal births. <jats:italic>Conclusions</jats:italic>. We emphasize health system particularities in Romania as triggers of high C-section rates that favor womens’ preferences against C-section medical indication.</jats:p>

Womenʼs assessment of the quality of hospital‐based perinatal care by mode of birth in Romania during the COVID‐19 pandemic: Results from the IMAgiNE EURO study

“…This may also have affected results; however, in which direction cannot be predicted. According to previous data, older mothers access health services more frequently 2 and may have higher risks of cesarean 4 ; however, their expectation of QMNC may also be higher. In view of these limitations, we cannot extrapolate the results to the entire population of mothers.…”

“…According to recent estimates, the cesarean rate in Romania is increasing significantly, with 37.1% of total births occurring by cesarean in 2016 2 ; this frequency reaches more than 80% in private clinics. 3 Several factors may be contributing to this high average rate of cesarean in Romania: few centers provide prenatal parental education, relatively high number of births in private clinics, low number of midwives, limited autonomy of midwives in the clinical decision process, women's preferences, 4 and increasing maternal age. 5,6 Although reducing the cesarean rate is recognized as a national priority, some of the current regulations (e.g., reimbursing hospitals with higher rates of cesarean compared with spontaneous vaginal birth [SVB]) may actually be a serious barrier to reducing the cesarean rate in Romania.…”

Prevalence and Risk Factors of Postpartum Depression in Romanian Women during Two Periods of COVID-19 Pandemic

“…It should be noted that an increased rate of caesarean section has been observed at the national level, which has been increasing in recent years, unrelated to the COVID-19 pandemic. In 2012, the rate of caesarean sections at the national level was 41.2% of all births, and in 2017, Romania was ranked second in Europe after Cyprus regarding this rate [ 42 , 43 ]. This high rate is mainly due to the desire of women, most caesarean sections being on request without an obstetric indication.…”

Predictors of planned caesarean section births in a sample of Romanian women

“…For example, in a study of 117 singleton pregnant women who gave birth at term, most unplanned CSs were attended by specialists whereas most vaginal births were attended by resident doctors. 7 Another research showed that less than 1% of women who gave birth in a tertiary maternity hospital between 2014 and 2020 delivered vaginally after having a caesarean delivery. 8 The latter means that virtually all women who gave birth by CS had a subsequent CS for their following pregnancy, contributing to the high rate of CS deliveries in Romania.…”

“…The few small studies conducted in Romania on this topic suggest that there are health system particularities that might favour CS deliveries. For example, in a study of 117 singleton pregnant women who gave birth at term, most unplanned CSs were attended by specialists whereas most vaginal births were attended by resident doctors 7 . Another research showed that less than 1% of women who gave birth in a tertiary maternity hospital between 2014 and 2020 delivered vaginally after having a caesarean delivery 8 .…”