Is high use of caesarean section sometimes justified?

Pratilas, Georgios Chrysostomos; Sotiriadis, Alexandros; Dinas, Konstantinos

doi:10.1016/s0140-6736(19)30221-1

Cited by 5 publications

(7 citation statements)

References 1 publication

(2 reference statements)

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“…Greece is a country with a high prevalence of Ceasarean Section deliveries (22) and with shrinking health care funding due to a prolonged period of austerity (23). Public Maternal Hospitals are sub-optimally staffed, low in recourses while proper and close monitoring of women in labour in one to one ratio is impossible and therefore many doctors resort to CSs (24). Nonetheless, the birth culture in Greece was highly medicalised even before the crisis since almost all births were performed in hospital settings in both the Greek National Health Service and the private health care system (25).…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Compassion Fatigue, Burn-Out and Compassion Satisfaction Among Maternity and Gynecology Care Providers in Greece

et al. 2019

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Introduction:Maternity and gynecology professionals are exposed to distressing events, trauma and suffering that may trigger compassion fatigue.Aim:The aim of this study was to investigate the prevalence of compassion fatigue/secondary traumatic stress (CF/STS), burnout (BO) and compassion satisfaction (CS) in maternity and gynecology care providers.Material and Methods:The Professional Quality of Life Scale (ProQOL R-IV) and a demographic and work-related characteristics questionnaire were distributed to 121 certified nurses, midwives and nurse/midwife assistants in 3 public hospitals in Greece.Results:The majority of participants were at the high-risk category for CF/STS (73.9%) while only 19.8% and 5% of nurses expressed high potential for CS and BO, respectively. Awareness of the factors associated with CF may help nurses to prevent or offset the development of this condition.Conclusion:A compassionate organizational culture, clinical supervision and on-going education may protect care providers from absorbing or internalizing unmanageable emotions which may lead to compassion fatigue and also help them to gain a deeper understanding of their communication and interactions during the emotionally laden moments of maternity and gynecology care.

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Section: Introductionmentioning

confidence: 99%

Prevalence of Compassion Fatigue, Burn-Out and Compassion Satisfaction Among Maternity and Gynecology Care Providers in Greece

et al. 2019

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“… d National data not available in Greece, estimate from WHO expert group. 20 e Data will be available starting in 2017. f Caesarean section rate updated from EPHR where 2014 data were used.…”

Section: Resultsmentioning

confidence: 99%

“…Greece does not have national data on the caesarean rate, so its rate was estimated from a WHO working group report (www.euro.who.int/en/countries/ greece/news/news/2016/11/greece-commits-to-addressingexcessive-reliance-on-caesarean-sections). 20 To compare the groups between countries, we produced graphs for each dimension of the recommended tables: the size of each group as a percentage of the total population of women having a live birth or stillbirth, the caesarean rate in each group and the absolute contribution of each group to the overall caesarean rate. To simplify the interpretation of this information, we ordered countries by their overall caesarean section rate from low to high.…”

Section: Analysis Strategymentioning

confidence: 99%

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Using Robson's Ten‐Group Classification System for comparing caesarean section rates in Europe: an analysis of routine data from the Euro‐Peristat study

Zeitlin

Durox

Macfarlane

et al. 2021

BJOG

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Objective Robson's Ten Group Classification System (TGCS) creates clinically relevant sub-groups for monitoring caesarean birth rates. This study assesses whether this classification can be derived from routine data in Europe and uses it to analyse national caesarean rates.Design Observational study using routine data.Setting Twenty-seven EU member states plus Iceland, Norway, Switzerland and the UK.Population All births at ≥22 weeks of gestational age in 2015.Methods National statistical offices and medical birth registers derived numbers of caesarean births in TGCS groups.Main outcome measures Overall caesarean rate, prevalence and caesarean rates in each of the TGCS groups.Results Of 31 countries, 18 were able to provide data on the TGCS groups, with UK data available only from Northern Ireland. Caesarean birth rates ranged from 16.1 to 56.9%. Countries providing TGCS data had lower caesarean rates than countries without data (25.8% versus 32.9%, P = 0.04). Countries with higher caesarean rates tended to have higher rates in all TGCS groups. Substantial heterogeneity was observed, however, especially for groups 5 (previous caesarean section), 6, 7 (nulliparous/multiparous breech) and 10 (singleton cephalic preterm). The differences in percentages of abnormal lies, group 9, illustrate potential misclassification arising from unstandardised definitions.Conclusions Although further validation of data quality is needed, using TGCS in Europe provides valuable comparator and baseline data for benchmarking and surveillance. Higher caesarean rates in countries unable to construct the TGCS suggest that effective routine information systems may be an indicator of a country's investment in implementing evidence-based caesarean policies.

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“…In the present study, the recorded incidence of C-sections was high compared to other studies. In particular, Greece is known to have a higher rate of performed C-sections [ 91 ], ranging from a mean of 41.6% recorded rate in the public setting to 53% in the private health sector [ 92 ]. Therefore, the recorded high rate herein does not appear to be the epiphenomenon of VLED or LED but is instead a reflection of a common practice among obstetricians throughout the country.…”

Section: Discussionmentioning

confidence: 99%

TIMER: A Clinical Study of Energy Restriction in Women with Gestational Diabetes Mellitus

et al. 2021

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Medical nutrition therapy is an integral part of gestational diabetes mellitus (GDM) management; however, the prescription of optimal energy intake is often a difficult task due to the limited available evidence. The present pilot, feasibility, parallel, open-label and non-randomized study aimed to evaluate the effect of a very low energy diet (VLED, 1600 kcal/day), or a low energy diet (LED, 1800 kcal/day), with or without personalized exercise sessions, among women with GDM in singleton pregnancies. A total of 43 women were allocated to one of four interventions at GDM diagnosis: (1) VLED (n = 15), (2) VLED + exercise (n = 4), (3) LED (n = 16) or (4) LED + exercise (n = 8). Primary outcomes were gestational weight gain (GWG), infant birth weight, complications at delivery and a composite outcomes score. Secondary outcomes included type of delivery, prematurity, small- for-gestational-age (SGA) or large-for-gestational-age (LGA) infants, macrosomia, Apgar score, insulin use, depression, respiratory quotient (RQ), resting metabolic rate (RMR) and middle-upper arm circumference (MUAC). GWG differed between intervention groups (LED median: 12.0 kg; VLED: 5.9 kg). No differences were noted in the type of delivery, infant birth weight, composite score, prevalence of prematurity, depression, RQ, Apgar score, MUAC, or insulin use among the four groups. Regarding components of the composite score, most infants (88.4%) were appropriate-for-gestational age (AGA) and born at a gestational age of 37–42 weeks (95.3%). With respect to the mothers, 9.3% experienced complications at delivery, with the majority being allocated at the VLED + exercise arm (p < 0.03). The composite score was low (range 0–2.5) for all mother-infant pairs, indicating a “risk-free” pregnancy outcome. The results indicate that adherence to a LED or VLED induces similar maternal, infant and obstetrics outcomes.

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Is high use of caesarean section sometimes justified?

Cited by 5 publications

References 1 publication

Prevalence of Compassion Fatigue, Burn-Out and Compassion Satisfaction Among Maternity and Gynecology Care Providers in Greece

Prevalence of Compassion Fatigue, Burn-Out and Compassion Satisfaction Among Maternity and Gynecology Care Providers in Greece

Using Robson's Ten‐Group Classification System for comparing caesarean section rates in Europe: an analysis of routine data from the Euro‐Peristat study

TIMER: A Clinical Study of Energy Restriction in Women with Gestational Diabetes Mellitus

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