Caesarean birth in public maternities in Argentina: a formative research study on the views of obstetricians, midwives, and trainees

Abstract

Objectives To explore obstetricians, midwives, and trainees perceptions of CS determinants in the context of public obstetric care services provision in Argentina. Our hypothesis is that known determinants of CS use may differ in settings with limited access to essential obstetric services. Setting We conducted a formative research study in nineteen public maternity hospitals in Argentina. An institutional survey assessed the availability of essential obstetric services. Subsequently, we conducted online surveys and semi-structured interviews to assess the opinions of providers on known CS determinants. Results Obstetric services showed an adequate provision of emergency obstetric care but limited services to support women during birth. Midwives, with some exceptions, are not involved during labour. We received 680 surveys from obstetricians, residents, and midwives (response rate of 63%) and interviewed 26 key informants. Six out of ten providers (411, 61%) indicated that the use of CS is associated with the complexities of our caseload. Limited pain management access was deemed a potential contributing factor for CS in adolescents and first-time mothers. Providers have conflicting views on the adequacy of training to deal with complex or prolonged labour Obstetricians with more than ten years of clinical experience indicated that fear of litigation was also associated with CS. Overall, there is consensus on the need to implement interventions to reduce unnecessary CS. Conclusions Public Maternity Hospitals in Argentina have made significant improvements in the provision of emergency services. The environment of service provision does not seem to facilitate the physiological process of vaginal birth. Providers acknowledged some of those challenges.

Women's mode of birth preferences and preparedness of hospitals to support vaginal birth in the public health sector in Argentina

“…The public obstetric services included in this study from five Argentinean regions reported an average caesarean delivery rate of 39% which was considered overuse of the procedure by the healthcare providers at the hospitals 19 . Despite the disproportionately high rates of caesarean birth, most postpartum women interviewed in these services indicated a preference for vaginal birth, citing faster recovery time, increased postpartum autonomy and ability to care for one's child, and a preference for a natural delivery as primary motives.…”

“…As part of a larger formative research project conducted by a multidisciplinary, international research partnership, 18,19 this study aimed to describe women's MOB preferences and identify the factors associated with those preferences in public hospitals in Argentina. Study findings will be used to inform the design and implementation of women‐centred interventions for reducing unnecessary caesarean birth in the Latin American region.…”