Obstetricians' attitudes to caesarean delivery on maternal request in Nigeria

Abstract

The study was done to determine obstetricians' attitude to and factors predicting obstetricians' acceptance of caesarean delivery on maternal request in Nigeria. Nigerian obstetricians were asked to respond to case scenarios depicting caesarean delivery on maternal request without medical indications and the reasons for their responses. The case scenarios were designed from previously published reasons for caesarean delivery on maternal request from Nigeria. Multiple logistic regressions analysis was done to determine factors predicting obstetricians' acceptance of caesarean delivery on maternal request out of respect for maternal autonomy. The majority (53.1%) of the respondents would accept caesarean delivery on maternal request out of respect for maternal autonomy. Caesarean requests backed up by social mitigating circumstances of previous childlessness and previous negative labour experience received significantly higher acceptances than requests with no back-up mitigating circumstances (p < 0.0001). A good proportion (48.8%) of Nigerian obstetricians had performed at least one caesarean on maternal request. Obstetricians' bio-professional characteristics do not influence their attitude to request caesarean delivery on maternal request. Some obstetricians expressed fear of legal consequences from caesarean delivery on maternal request.

Clinicians’ views of factors influencing decision-making for caesarean section: A systematic review and metasynthesis of qualitative, quantitative and mixed methods studies

“…Just one study, in Nigeria, reported that obstetricians perceived the threat of litigation to be greater after performing CS because women believed that complications arising from natural vaginal birth were unavoidable [ 34 ]. In Weaver et al ’s study (2007), litigation was cited as one of the main reasons to perform CS by 67% (n = 525) of obstetricians in UK and Ireland [ 51 ].…”

“…This subtheme reported in eight studies, included obstetricians’ views of the influence of their personal demographics, such as age, gender and professional status on the decision-making for CS. Three of these studies reported no influence of obstetricians’ demographics [ 34 , 42 , 45 ], and the remaining five studies reported some influence [ 29 , 38 , 40 , 47 , 49 ].…”

Shared decision‐making in maternity care: Acknowledging and overcoming epistemic defeaters

“…This is borne out in the literature, where clinicians have noted that women request CS for a variety of reasons including a previous poor birth experience or fear of labour as well as for social and cultural factors or body image . In general, obstetricians are seen as more likely than midwives to agree to a women's request for CS . A recent study, interviewing 11 midwives and five obstetricians in Sweden, where the CS rate is only 17%, found that women were very involved in decision‐making for most aspects of care, including CS on request in very rare situations .…”

“…15,17,18 In general, obstetricians are seen as more likely than midwives to agree to a women's request for CS. [19][20][21][22] A recent study, interviewing 11 midwives and five obstetricians in Sweden, where the CS rate is only 17%, found that women were very involved in decision-making for most aspects of care, including CS on request in very rare situations. 23 The midwives described how women who were fearful of birth were cared for: 23(p4) This description seems to epitomize SDM at its best and, as can be clearly seen from the overall low CS rate, did not lead to high intervention rates because the Swedish clinicians had an overriding belief in, and support of, normal birth, 23 the term commonly used to convey no interference with physiological labour and birth processes.…”

The influence of individual provider characteristics and attitudes on caesarean section decision-making: a global review

“…A total of 16 studies investigated the association between provider characteristics and CS decision-making. Of the nine studies examining the association between provider gender and CS decision-making, Four four studies observed no difference by gender in providers' willingness to offer VBAC in women with: two prior CS (Doret et al, 2010(Doret et al, )(M. et al, 201027, acceptance of CS on maternal request (Chigbu, Ezenyeaku and Ezenkwele, 2010), or obstetrician CS rates (Dweik et al, 2014;Ito et al, 2014) (Dweik et al, 2014). In clinical scenarios, the odds of male providers were more likely to recommending CS were 1.50 to 2.74 times higher than for female providers (OR= 1.50; 95% CI 1.05 -2.13) in the United States (Cheng et al, 2014) and Russia (Danishevski et al, 2008;Cheng et al, 2014) (OR=2.74, p=0.015) (Cheng, Snowden, Handler, Tager, Hubbard, Caughey, et al, 2014); male providers were also more likely to accept CS on maternal request with previous complicated deliveries (OR= 1.92; p<0.001) in Norway (Fuglenes, Øian and Kristiansen, 2009) and to agree with CS on maternal request in Sweden (p<0.001) (Gunnervik et al, 2008).…”