Predictors of caesarean section – a cross-sectional study in Hungary

Rénes, Lórand; Barka, Nikoletta; Gyurkovits, Zita; Paulik, Edit; Németh, Gábor; Orvos, Hajnalka

doi:10.1080/14767058.2017.1285888

Cited by 15 publications

(16 citation statements)

References 22 publications

(46 reference statements)

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“…Often there is ambiguity around what health professionals believe are clinical indications for CS [ 16 ]. Changing risk profiles and maternal characteristics, such as increasing maternal age and high BMI [ 23 – 26 ], treatment for infertility [ 27 ], are reported as contributing to the rise in CS, which resonate with clinicians’ views in this study. Change in maternal demographics partly contributes to the decision-making for CS; however, this does not fully explain the overall decision-making, and rising CS rates in nulliparous women [ 25 ].…”

Section: Discussionsupporting

confidence: 65%

Clinicians’ views of factors influencing decision-making for CS for first-time mothers—A qualitative descriptive study

2022

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Clinicians’ perspectives of the reasons for performing caesarean section (CS) are fundamental to deepening knowledge and understanding of factors influencing decision-making for CS. The aim of this study was to explore midwives’ and obstetricians’ views of factors influencing decision-making for CS for first-time mothers. A qualitative descriptive study with semi-structured one-to-one audio-recorded interviews was used to gather data from clinicians (15 midwives and 20 senior obstetricians). Following research ethics committee approval, clinicians, who were directly involved in the decision-making process for CS during the period of data collection, were purposively selected from three maternity units in the Republic of Ireland between June 2016 to July 2017. The interviews were transcribed verbatim and analysed thematically. Three interrelated themes with several subthemes reflective of clinicians’ views and experiences emerged following data analysis. These were: ‘A fear factor’ describing clinicians’ fear of adverse outcomes and subsequent litigation, ‘Personal preferences versus a threshold–clinician driven factors emphasising the influence of clinicians’ personal beliefs, and ‘Standardised versus individualised care–a system perspective’ explaining the effects of, or lack of, organisational policy and its direct and indirect impact on the decision-making process. Findings show that decisions to perform a CS are, on occasion, based on clinicians’ personal beliefs and interpretation, similar to findings from other published literature. Consideration of broader issues related to organisational, socio-cultural and political context is essential when seeking solutions to the rising CS rates. The findings will enable clinicians to reflect on their day-to-day practice, in order to look for modifiable factors that influence their decision-making, and help women understand the multitude of factors that can lead to a decision to perform a CS. Findings will also contribute to the development of the ‘next step action’ and assist in devising future intervention studies to reduce any unnecessary CSs.

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Section: Discussionsupporting

confidence: 65%

Clinicians’ views of factors influencing decision-making for CS for first-time mothers—A qualitative descriptive study

2022

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“…Mode of birth and associated outcomes are widely debated because of the absence of clear reasons, increasing CS rates, and the belief that some CSs are unnecessary, [ 3 ] and lack of rationale for the steady rise [ 1 ]. Some of the factors contributing to the rise in rates include complexities associated with caring for women with a high body mass index (BMI) or following infertility treatment [ 4 , 5 , 6 ], however, many factors remain under explored or poorly explained [ 7 ]. There are some suggestions that some CSs are performed without medically justifiable reasons [ 8 ] or are attributable to women’s choice.…”

Section: Introductionmentioning

confidence: 99%

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

2018

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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.

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“…In recent years, changing maternal characteristics and risk profiles, such as increasing maternal age and high BMI, treatment for infertility, 4,10,22 are frequently reported as being associated with the increase in CBs. These resonate with our study with twofold increased risk of CB for women aged ≥40 years, one and half times increased risk for women with high BMI and doubled risk for women who had treatment for infertility.…”

Section: Discussionmentioning

confidence: 99%

“…7,8 Several factors are associated with the rising rates of CB. An increase in CB among nulliparous women has been associated with increasing risk factors such as advanced maternal age, obesity 9 , previous treatment for infertility and hypertension/pregnancy-induced hypertension, 10 or maternal age. 11 There is consensus around clinical reasons for CB, such as labor dystocia, fetal distress, and acute clinical emergency (eg, severe antepartum hemorrhage or umbilical cord prolapse).…”

Section: Introductionmentioning

confidence: 99%

Factors associated with cesarean birth in nulliparous women: A multicenter prospective cohort study

Panda

Begley

Corcoran

et al. 2022

Birth

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Background There is widespread concern around the rising rates of cesarean births (CBs), especially among first‐time mothers, despite evidence suggesting increased morbidities after birth by cesarean. There are uncertainties around factors associated with rising rates of CBs among first‐time mothers in Ireland, and insight into these is essential for understanding the rising trend in CBs. Therefore, this study aimed to identify the factors associated with CBs in nulliparous women. Methods A prospective cohort study was conducted in three maternity hospitals in the Republic of Ireland between 2012 and 2017. Data were collected from 3047 nulliparous women using self‐administered surveys antenatally and at 3 months postpartum and from consenting women’s hospital records (n = 2755) and analyzed using the Poisson regression to assess associations between demographic and clinical factors and the main outcome measures, planned and unplanned CBs. Results Common risk factors for planned and unplanned CBs were being aged ≥40 years, being in private care, multiple pregnancy, and fetus in breech or other malpresentations. An unplanned CB occurred for 22.43% (n = 377/1681) of women who did not have induction of labor (IOL) or who had IOL with no epidural, but the risk was about twice as high for women who had IOL and epidural. Conclusions Findings confirm multifactorial reasons for CB and the challenge of reversing the increasing CB rate if maternal age, overweight/obesity, infertility treatment, multiple pregnancy, and preexisting hypertension in Ireland continue to increase. There is a need to address prelabor interventions, especially IOL combined with epidural analgesia with respect to unplanned CB.

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Predictors of caesarean section – a cross-sectional study in Hungary

Abstract: Pre-gestational obesity, infertility treatment, previous CS and HT/PIH had significant effect on the mode of delivery.

Cited by 15 publications

References 22 publications

Clinicians’ views of factors influencing decision-making for CS for first-time mothers—A qualitative descriptive study

Clinicians’ views of factors influencing decision-making for CS for first-time mothers—A qualitative descriptive study

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

Factors associated with cesarean birth in nulliparous women: A multicenter prospective cohort study

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