Original Articles

Obstetricians’ Views for Reasons Decision-Making for Cesarean Section in Iran

Abstract

By increasing trend of cesarean sections (c-section) has raised the rate of health implications after c-section analogously. This study aimed to identify the factors influencing the choice of cesarean birth from obstetrician' perspective. Present study was a descriptive-analytical cross-sectional study at three medical centers dependent on Tehran University of Medical Sciences in 2022. The questionnaire included parents' demographic and economic factors, parents 'previous experiences and insistence of relatives, environmental and facilities, cultural and religious, the doctor's personal opinion, and the mother's clinical and psychological factors. In general, 67 gynecologists participated in the study. The average (SD) age and work experience of doctors was 42.95 (7.68), and 11.49 (8.35) years respectively. The most determining factors in the choice of cesarean delivery from the doctor's point of view were the maternal clinical and psychological factors. Other important factors were the culture and personal beliefs of the parents. The factor of fear of litigation and court in case of birth problems and complications was one of the other essential factors in choosing cesarean delivery. In the current study, the age and experience of the specialist doctor showed a positive correlation with the personal opinion of the gynecologists. Obstetricians and gynecologists are the final decision makers in choosing the type of delivery. To select the correct method, there is a need for a specific protocol for choosing the kind of delivery, and providing a suitable platform to resolve legal concerns and lawsuits.

 

1. World Health Organization. Caesarean section rates continue to rise, amid growing inequalities in access. (Accessed 16 June, 2021, at https://www.who.int/news/item/16-06-2021-caesarean-section-rates-continue-to-rise-amid-growing-inequalities-in-access).
2. WHO Session. J Obstet Gynaecol Res 2023;49:87-9.
3. Boatin AA, Ngonzi J, Ganyaglo G, Mbaye M, Wylie BJ, Diouf K. Cesarean delivery in low- and middle-income countries: A review of quality of care metrics and targets for improvement. Semin Fetal Neonatal Med 2021;26:101199.
4. Almgren M, Schlinzig T, Gomez-Cabrero D, Gunnar A, Sundin M, Johansson S, et al. Cesarean delivery and hematopoietic stem cell epigenetics in the newborn infant: implications for future health? Am J Obstet Gynecol 2014;211:502.e1-8.
5. Schuitemaker N, van Roosmalen J, Dekker G, van Dongen P, van Geijn H, Gravenhorst JB. Maternal mortality after cesarean section in The Netherlands. Acta Obstet Gynecol Scand 1997;76:332-4.
6. Sobhy S, Arroyo-Manzano D, Murugesu N, Karthikeyan G, Kumar V, Kaur I, et al. Maternal and perinatal mortality and complications associated with caesarean section in low-income and middle-income countries: a systematic review and meta-analysis. Lancet 2019 May 11;393:1973-82.
7. Liu S, Liston RM, Joseph KS, Heaman M, Sauve R, Kramer MS, et al. Maternal mortality and severe morbidity associated with low-risk planned cesarean delivery versus planned vaginal delivery at term. CMAJ 2007;176:455-60.
8. Miseljic N, Ibrahimovic S. Health Implications of Increased Cesarean Section Rates. Mater Sociomed 2020;32:123-6.
9. Shahshahan Z, Heshmati B, Akbari M, Sabet F. Caesarean section in Iran. Lancet 2016;388:29-30.
10. Colomar M, Cafferata ML, Aleman A, Castellano G, Garcia-Elorrio E, et al. Mode of childbirth in low-risk pregnancies: Nicaraguan physicians' viewpoints. Matern Child Health J 2014;18:2382-92.
11. Kamal P, Dixon-Woods M, Kurinczuk JJ, Oppenheimer C, Squire P, Waugh J. Factors influencing repeat caesarean section: qualitative exploratory study of obstetricians' and midwives' accounts. BJOG 2005;112:1054-60.
12. Yazdizadeh B, Nedjat S, Mohammad K, Rashidian A, Changizi N, Majdzadeh R. Cesarean section rate in Iran, multidimensional approaches for behavioral change of providers: a qualitative study. BMC Health Serv Res 2011;11:159.
13. Bettes BA, Coleman VH, Zinberg S, Spong CY, Portnoy B, DeVoto E, et al. Cesarean delivery on maternal request: obstetrician-gynecologists' knowledge, perception, and practice patterns. Obstet Gynecol 2007;109:57-66.
14. Cox KJ. Providers' perspectives on the vaginal birth after cesarean guidelines in Florida, United States: a qualitative study. BMC Pregnancy Childbirth 2011;11:72.
15. Huang K, Tao F, Faragher B, Raven J, Tolhurst R, Tang S, et al. A mixed-method study of factors associated with differences in caesarean section rates at community level: the case of rural China. Midwifery 2013;29:911-20
16. Karlström A, Engström-Olofsson R, Nystedt A, Thomas J, Hildingsson I. Swedish caregivers' attitudes towards caesarean section on maternal request. Women Birth 2009;22:57-63.
17. Weaver JJ, Statham H, Richards M. Are there "unnecessary" cesarean sections? Perceptions of women and obstetricians about cesarean sections for nonclinical indications. Birth 2007;34:32-41
18. Mazzoni A, Althabe F, Gutierrez L, Gibbons L, Liu NH, Bonotti AM, et al. Women's preferences and mode of delivery in public and private hospitals: a prospective cohort study. BMC Pregnancy Childbirth 2016;16:34.
19. Panda S, Begley C, Daly D. Clinicians' views of factors influencing decision-making for caesarean section: A systematic review and metasynthesis of qualitative, quantitative and mixed methods studies. PLoS One 2018;13:e0200941.
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IssueVol 62 No 3 (2024) QRcode
SectionOriginal Articles
DOI https://doi.org/10.18502/acta.v62i3.17140
Keywords
Cesarean section Delivery Obstetric/adverse effects Obstetric/complications Obstetric/mortality
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Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Hantoosh Zadeh S, Shariat M, Mousavi A-S, Sahebi L, Moradi R, Farrokhzad N. Obstetricians’ Views for Reasons Decision-Making for Cesarean Section in Iran. Acta Med Iran. 2024;62(3):166-172.