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

Abstract

Background: This paper reports on postpartum women's mode of birth (MOB) preferences across five public maternity hospitals in Argentina, the variables and motives associated with those preferences, and hospital services preparedness. Methods: A cross-sectional study was conducted with postpartum women aged 15 years or older in geographically diverse public hospitals in Argentina between November 2018 to June 2019. Data on obstetric history, companionship, and MOB preference and motives were collected from mothers using a semistructured interviewer-administered questionnaire. Hospital and participant characteristics, MOB preferences, and perceived advantages and disadvantages were described. Associations between vaginal birth preference, participant characteristics, and hospitals were assessed using odds ratios generated from mixed-effect logistic regression analyses. Results: The sample included 621 postpartum women, 60% of whom had a vaginal birth. In three of the participating hospitals, most women indicated vaginal birth as their preferred MOB (90%); however, the preference for a vaginal birth was lower in the remaining two hospitals (67%). Differences in preferences across hospitals remained after adjusting by women's age or obstetric history. Cited motives for vaginal birth preference included faster recovery, feeling ready for a vaginal birth, and considering it a more natural process. Preference for a caesarean birth was based on perceptions of increased safety and avoiding pain. Conclusions: The characteristics of obstetric services revealed they are prepared for obstetric emergencies but have limited resources and support to sustain the process of vaginal birth. Despite the limited support, women giving birth in public maternity hospitals preferred vaginal delivery to a caesarean section. This study could not identify hospital variables associated with women's birth preferences across hospitals.

A bit of medical paternalism? A qualitative study on power relations between women and healthcare providers when deciding on mode of birth in five public maternity wards of Argentina

“…HCPs also mention misinformation about the risks and benefits of each mode of birth as a contributing factor for CS upon maternal request. The aforementioned study from Argentina showed that the main reason for women preferring a CS was that they perceived it as a safer option than VB [ 47 ], which is in line with research conducted in other countries [ 57 , 60 – 63 ] but contradicts the available evidence on the risks and benefits of each mode of birth [ 14 , 64 ]. According to the interviewees, women are also influenced by media, which has been identified as having a significant role in agenda setting for fashionable trends regarding mode of birth [ 65 ].…”

“…This is in line with previous literature, which has shown that fear of pain during labour is a reason for women to prefer a CS [ 9 , 54 – 58 ]. Recent quantitative studies on women’s preferences on mode of birth in Argentina and Brazil indicated that avoiding pain was one of the main reasons put forward by women preferring a CS to a VB [ 47 , 59 ]. An important contextual factor to take into consideration is that only one out of the five participating hospitals provides epidural analgesia during labour as a routine practice.…”

“…This formative research was commissioned by the World Health Organization conducted by Centro de Estudios de Estado y Sociedad (CEDES) and Centro Rosarino de Estudios Perinatales (CREP). Results of the mixed-method study have been published elsewhere [ 47 , 48 ] and have been used to inform the adaptation of non-clinical interventions to optimize the use of CS within the study “Quality decision-making (QUALI-DEC) by women and healthcare providers for appropriate use of caesarean section” [ 46 ]. Here we present further in-depth analysis of the qualitative interviews conducted during the formative research.…”

Implementing the QUALI-DEC project in Argentina, Burkina Faso, Thailand and Viet Nam: a process delineation and theory-driven process evaluation protocol

“…Implementing partners in participating countries, and supporting partners not directly involved in implementation, conducted research including 1) a document review where the teams in Argentina, Burkina Faso, Viet Nam and Thailand collected information on health system structures such as legal aspect and financing, 2) a readiness assessment of all included healthcare facilities to understand workload, staffing, space, equipment, existing clinical practice guidelines and supplies, and 3) qualitative in-depth interviews with women, their potential companions, healthcare providers and administrators. In Argentina, the formative research phase built on work conducted prior to the initiation of QUALI-DEC [ 18 , 19 ]. Project timelines per country are presented in supplementary Table S1.…”