An Uninformed Decision-Making Process for Cesarean Section: A Qualitative Exploratory Study among the Slum Residents of Dhaka City, Bangladesh

Abstract

The decision-making process and the information flow from physicians to patients regarding deliveries through cesarean section (C-section) has not been adequately explored in Bangladeshi context. Here, we aimed to explore the extent of information received by mothers and their family members and their involvement in the decision-making process. We conducted a qualitative exploratory study in four urban slums of Dhaka city among purposively selected mothers (n = 7), who had a cesarean birth within one-year preceding data collection, and their family members (n = 12). In most cases, physicians were the primary decision-makers for C-sections. At the household level, pregnant women were excluded from some crucial steps of the decision-making process and information asymmetry was prevalent. All interviewed pregnant women attended at least one antenatal care visit; however, they neither received detailed information regarding C-sections nor attended any counseling session regarding decisions around delivery type. In some cases, pregnant women and their family members did not ask health care providers for detailed information about C-sections. Most seemed to perceive C-sections as risk-free procedures. Future research could explore the best ways to provide C-section-related information to pregnant women during the antenatal period and develop interventions to promote shared decision-making for C-sections in urban Bangladeshi slums.

Knowledge, Attitudes and Practices Towards Psoriasis Among Patients and Their Family Members

“…This inclusion might encompass educating family members on the significance of treatment adherence, accentuating their supportive role, and cultivating an environment conducive to sustained compliance. 28 …”

“…family members on the significance of treatment adherence, accentuating their supportive role, and cultivating an environment conducive to sustained compliance. 28 A noteworthy observation is the consistency in the questions related to the "K" dimension across both patient and family member questionnaires, yet a contrasting positive effect in the SEM results for family members. This intriguing phenomenon warrants in-depth exploration to discern potential reasons behind this positivity among family members, despite the shared questionnaire content.…”

Urgent need to address increasing caesarean section rates in lower-middle-income countries like Bangladesh

“…One previous study reported that physicians and the breadwinner of the pregnant woman’s family are the primary decision-makers behind CS delivery and that pregnant women are often excluded from that decision-making process ( 9 ). Thus, women are probably not aware that an unnecessary CS can result in increased risk of infection, potential complications in subsequent pregnancies, and prolonged recovery times ( 10 ). Previous evidence has shown that a combination of sociocultural factors, such as education, social class, and religion, and medical factors, such as pregnant women’s high blood pressure and/or diabetes, contributes to this increasing CS rate ( 2 ).…”

Variation of caesarean section rates in Palestinian governmental hospitals

“…Also, they describe ideal situations which require more financial and human resources than are readily available. They call for continuous training by specialists, increasing the financial burden and workload on most hospitals [9]. Finally, the guidelines lack a clear scientific base regarding data sources or human sources responsible for creating them.…”

“…Studies showed the process of decision-making could impact C-section choice. This process affects by doctors' beliefs of what is supposed medical or medical indications, absences of collective decision between staff as to lack of cooperation among midwives [8] and gynecologists, and maternal requests, and it is a crucial part of women's involvement in the decision-making process [9].…”