Obstetrical providers’ preferred mode of delivery and attitude towards non-medically indicated caesarean sections: a cross-sectional study

RIVO, J.C.; AMYX, M.; PINGRAY, V.; CASALE, R.A.; FIORILLO, A.E.; KRUPITZKI, H.B.; MALAMUD, J.D.; MENDILAHARZU, M.; MEDINA, M.L.; DEL PINO, A.B.; RIBOLA, L.; SCHVARTZMAN, J.A.; TARTALO, G.M.; TRASMONTE, M.; VARELA, S.; ALTHABE, F.; BELIZÁN, J.M.; CORMICK, GABRIELA

BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY

WILEY-BLACKWELL PUBLISHING, INC

Año: 2018 vol. 125 p. 1294 - 1302

1470-0328

Objective: To describe obstetrical providers? delivery preferences and attitudes towards caesarean section without medical indication, including on maternal request, and to examine the association between provider characteristics and preferences/attitudes. Design: Cross-sectional study. Setting: Two public and two private hospitals in Argentina. Population: Obstetrician-gynaecologists and midwives who provide prenatal care and/or labour/delivery services. Methods: Providers in hospitals with at least 1000 births per year completed a self-administered, anonymous survey. Main outcome measures: Provider delivery preference for low-risk women, perception of women´s preferred delivery method, support for a woman´s right to choose her delivery method and willingness to perform caesarean section on maternal request. Results: 168 providers participated (89.8% coverage rate). Providers (93.2%) preferred a vaginal delivery for their patients in the absence of a medical indication for caesarean section. Whereas 74.4% of providers supported their patient´s right to choose a delivery method in the absence of a medical indication for caesarean section and 66.7% would perform a caesarean section upon maternal request, only 30.4% would consider a non-medically indicated caesarean section for their own personal delivery or that of their partner. In multivariate adjusted analysis, providers in the private sector [odds ratio (OR) 4.70, 95% CI 1.19?18.62] and obstetrician-gynaecologists (OR 4.37, 95% CI 1.58?12.09) were more willing than either providers working in the public/both settings or midwives to perform a caesarean section on maternal request. Conclusions: Despite the ethical debate surrounding non-medically indicated caesarean sections, we observe very high levels of support, especially by providers in the private sector and obstetrician-gynaecologists, as aligned with the high caesarean section rates in Argentina. Tweetable abstract: Non-medically indicated c-section? 74% of sampled Argentine OB providers support women´s right to choose.