PubMed · 13198791
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J J FIGOUREUX. 1954-08-15. [Cesarean section].. https://pubmed.ncbi.nlm.nih.gov/13198791/
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OBJECTIVE: To examine obstetrician-gynecologists' knowledge, opinions, and practice patterns related to cesarean delivery on maternal request. METHODS: Questionnaires were mailed to 1,031 American College of Obstetricians and Gynecologists Fellows in February 2006, with a response rate of 68%. The questionnaire queried respondents' demographic characteristics, practices and attitudes surrounding vaginal and cesarean deliveries, knowledge and beliefs regarding the risks and benefits of elective and nonelective cesarean delivery, and counseling practices and department policies for cesarean delivery on maternal request. RESULTS: About half of respondents believe women have the right to cesarean delivery on maternal request, and a similar percentage acknowledge having performed at least one cesarean delivery on maternal request. Fifty-eight percent of respondents note an increase in patient inquiries regarding cesarean delivery over the past year, yet most of their practices do not have a policy regarding this procedure. Respondents attribute the increase in inquiries to the increase of information from the media and to convenience. Respondents cited more risks than benefits of cesarean delivery on maternal request, and nearly all discuss these risks with patients who are considering one. Females were more negative toward cesarean delivery on maternal request than males and endorsed more risks and fewer benefits. There were no relationships between assessment of risks and benefits or practice with clinician age or patient characteristics. CONCLUSION: Most obstetrician-gynecologists in this study recognized an increased demand for cesarean delivery on maternal request within their practices, while believing that the risks of this procedure outweigh the benefits. Clinicians would benefit from strong evidence regarding risks and benefits, evidence that is crucial to guiding policy making with regard to cesarean delivery on maternal request. LEVEL OF EVIDENCE: III.
OBJECTIVE: This study aims to analyse the environment encouraging C-section in Lebanon and to reveal approaches that could be adopted for the reduction of this practice, by considering the attitudes, opinions and actions of different stakeholders. METHODS: Semi-structured interviews were conducted with 20 selected key players, including hospital directors, midwives, insurance bodies, syndicates and scientific societies, ministries, international agencies, medical schools, media representatives and women's groups. In addition, a group discussion was conducted with 10 obstetricians. Semi-structured interviews were conducted with a convenience sample of 36 women who had a C-section within 4 months preceding the study. Data was analysed using the Policy Maker software version 2.3. RESULTS: Findings of the study point to the role of multiple factors in shaping the current practices related to C-section deliveries, among which are the organisation of the health care system, the dominance of the private sector, the lack of physician accountability, the minimisation of midwives' roles in the process and women's misconceptions about C-sections. CONCLUSIONS: Involvement of the diversity of players is important to change practices in maternity care in Lebanon, after considering their position and power. Different strategies making use of available opportunities to improve the current situation are discussed.
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