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.

No abstract

Shared decision‐making involves health professionals and patients/clients working together to achieve true person‐centred health care. However, this goal is infrequently realized, and most barriers are unknown. Discussion between philosophers, clinicians, and researchers can assist in confronting the epistemic and moral basis of health care, with benefits to all. The aim of this paper is to describe what shared decision‐making is, discuss its necessary conditions, and develop a definition that can be used in practice to support excellence in maternity care. Discussion between the authors, with backgrounds in philosophy, clinical maternity care, health care management, and maternity care research, assisted the team to confront established norms in maternity care and challenge the epistemic and moral basis of decision‐making for caesarean section. The team concluded that shared decision‐making must start in pregnancy and continue throughout labour and birth, with equality in discourse facilitated by the clinician. Clinicians have a duty of care for the adequacy of women's knowledge, which can only be fulfilled when relevant knowledge is offered freely and when personal beliefs and biases that may impinge on decision‐making (defeaters) are disclosed. Informed consent is not shared decision‐making. Key barriers include existing cultural norms of “the doctor knows best” and “patient acquiescence” that prevent defeaters being acknowledged and discussed and can lead to legal challenges, overuse of medical intervention and, in some areas, obstetric violence. Shared decision‐making in maternity care can thus be defined as an enquiry by clinician and expectant woman aimed at deciding upon a course of care or none, which takes the form of a dialogue within which the clinician fulfils their duty of care to the client's knowledge by making available their complete knowledge (based on all types of evidence) and expertise, including an exposition of any relevant and recognized potential defeaters. Research to develop measurement tools is required.

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.

No abstract

Purpose – The purpose of this paper is to attempt to test a model of talent development interventions and find out the various factors which actually impact the process in a manufacturing concern. Design/methodology/approach – Multiple regression analysis is used to analyse the data and find the extent to which the variables considered are significant predictors of talent development. Primary data are collected from the respondents (executives) of two manufacturing units with the help of a structured questionnaire. A sample size of 200 is considered for extraction of data for the study. Findings – The results of the study highlight that six of the independent variables significantly predict the dependent variable. This paper identifies the most important factors which are found to be pivotal for the development of talent in the organizations considered for the study. Practical implications – Managing talent in the present competitive business scenario is one of the most vital issues in which HR professionals/practitioners are involved. It becomes imperative for top management to know about the various ways which can aid in proper development of talent. This paper empirically identifies the various strategic interventions which aid in the proper development of talent in manufacturing sector. Originality/value – While there are many papers tracing the talent development process and the various strategic interventions, there is a dearth of empirical research being done in this field in the manufacturing sector. This paper attempts to explore the developmental interventions in the manufacturing sector and adds new insights on an empirical basis.

No abstract

Background: Women who birth by caesarean section are more likely to require readmission to hospital following birth compared to women who birth vaginally.Aim: to examine the reasons, management and outcomes for women readmitted to hospital following birth by caesarean section (CS). Methods:A retrospective audit of maternity records. Results:The total number of births for the period of data extraction was 8580 of which 2470 (28.8%) women gave birth by CS. A total of 107 women (4.3% of the total number of women who gave birth by CS) were readmitted to hospital between 1st August 2014 and 31st July 2015, of which 46 women (1.9%) were readmitted following elective and 61 (2.5%) following emergency CS. The average length of hospital stay was 2.64 and 4.61 nights respectively and the average timeline for readmission was 14.6 (following elective CS) and 15.7 (following emergency CS). The most common reason for readmission was wound infection, with the majority of women requiring analgesics (n=29, 63.05% (following elective CS) and n=51, 83.61% (following emergency CS)) and intravenous antibiotics (n=23, 50% (following elective CS) and n=34, 55.74% (following emergency CS)). Conclusion:Abdominal wound infection is one of the most common reasons for readmission of women to the hospital following birth by CS. These findings will make it easier to understand and identify women at risk of postpartum morbidity following birth by CS. Key points Readmission following birth has implications for the health service, in terms of women's length of stay in hospital and management (investigations and treatment) during the period of readmission. It also leads to cost implications which can be further explored in future audits. An audit was conducted using retrospective data from the hospital database of 107 women readmitted to a large Irish maternity hospital following birth by CS to look into the reasons for readmission, management and outcomes for women. Abdominal wound infection was one of the most common reasons for readmission of women (n=13, 28.27% (elective) compared with n=26, 42.63% (emergency)).