Dataset Information

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

ABSTRACT: 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.

SUBMITTER: Rivo JC

PROVIDER: S-EPMC6041183 | biostudies-literature | 2018 Sep

REPOSITORIES: biostudies-literature

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

Rivo J C JC Amyx M M Pingray V V Casale R A RA Fiorillo A E AE Krupitzki H B HB Malamud J D JD Mendilaharzu M M Medina M L ML Del Pino A B AB Ribola L L Schvartzman J A JA Tartalo G M GM Trasmonte M M Varela S S Althabe F F Belizán J M JM

BJOG : an international journal of obstetrics and gynaecology 20180222 10

<h4>Objective</h4>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.<h4>Design</h4>Cross-sectional study.<h4>Setting</h4>Two public and two private hospitals in Argentina.<h4>Population</h4>Obstetrician-gynaecologists and midwives who provide prenatal care and/or labour/delivery services.<h4>Methods</h4> ...[more]

PMID: 29325216

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Project description:BackgroundCOVID-19 has a devastating effect on social, economic, and political crises that will leave deep pockmarks on victims of the virus. Having poor knowledge and attitude of the disease among health care providers could bring in impeded effect in the supportive treatment and, it increases the spread of the pandemic.ObjectiveThe study aims to assess the knowledge and attitude towards COVID-19, and associated factors among health care providers in Northwest Ethiopia in 2020.MethodsInstitution based cross-sectional study was conducted from the mid of March to the end of April 2020 among 408 participants who were selected by a simple random sampling technique. Pretested and structured self-administered questionnaire was used to collect data. The data were entered using EPI-info v. 7, and were exported to SPSS version 20 for further analysis. Bivariate and multivariable logistic regression analyses were used to identify factors associated with Knowledge and Attitude towards COVID-19. Variables having p-value < 0.05 were taken as variables which were significantly associated with the dependent variable.ResultA total of 408(97.1%) participants have participated in the study. Most of the participants (67.3%) were males. One-third (35.5%) of the participants were nurses. About 62% of the health care providers were Bachelor degree holders. The prevalence of Knowledge and attitude towards COVID-19 found to be 73.8% (95%CI: 69.9, 77.9) and 65.7% (95%CI: 61.5, 70.1) respectively. Master degree level of education (AOR = 2.85; 95% CI: 1.25, 6.00) was associated with knowledge of the participants. Similarly, having good knowledge (AOR = 3.17; 95%CI: 1.97, 5.06) was positively associated with the attitude of health care providers towards COVID-19.Conclusion and recommendationHealth care providers found to have good knowledge and attitude towards COVID-19. Being Master's Degree holder and having good knowledge are associated with the knowledge and attitude of the respondents towards COVID-19 respectively. Thus, improving awareness through health education is a significant approach to address the global agenda of COVID-19 Pandemic.

Project description:BACKGROUND:Unsafe abortion remains a reality for many Ethiopian women and will remain so until safe abortion is more accessible across the country. The house of representatives of Federal Democratic Republic of Ethiopia (FDRE) revised the abortion law and Ministry of Health (MoH) of FDRE developed a revised technical and procedural guideline for safe abortion services in Ethiopia; emphasizing the need to increase knowledge and practice of health service providers on safe abortion care (SAC) and access to safe terminations of pregnancy at high standard and quality. METHODS:A facility based descriptive cross-sectional study using structured self-administered questionnaire was conducted between July and August 2015. A total of 405 mid-level providers (MLPs) including midwives, clinical nurses and health officers were included from 30 randomly selected health centers in Addis Ababa. SPSS version-21 was used for data entry, cleaning and analysis. The results were presented using frequency tables, percentages, means, Odds ratio and 95% confidence limits. RESULTS:Among 405 MLPs 71.9% knew the definition of abortion in the in Ethiopia context, 81.5% participants were familiar with the revised abortion law. 53.1% of respondents had adequate knowledge on safe abortion care and working for 3-5?years (AOR 3.1 with CI 1.6, 5.7) and midwives (AOR?=?2.9 with CI 1.8, 4.7) had better knowledge on abortion. Only eighty-three (20.5%) of MLPs were trained on safe abortion and among them sixty-eight (81.9%) were practising/used to practice safe abortion services. Half of respondents gave post abortion family planning methods. 54.1% respondents had positive attitude towards safe abortion. MLPs' who had adequate knowledge on safe abortion care (AOR 2.02, 95% CI 1.3-3.1) and male providers (AOR 1.6, 95% CI 1.04-2.4) were more likely to have positive attitude towards safe abortion. MLPs who had adequate knowledge on abortion 3.4 times (CI of 95% =1.1-10.6) were more likely to practise safe abortion care. CONCLUSION:The majority claimed to know the current abortion law; however, many failed to understand the specific provisions of the law. Type of profession and years of experiences were important in explaining providers' knowledge related to abortion. Being male and having the knowledge significantly influenced providers' attitude toward safe abortion. Knowledge related to abortion also influenced the practice of SAC. Efforts to improve mid-level as well as other health care providers' knowledge on abortion are necessary, for example, through pre-/on-service training.

Project description:BackgroundCaesarean sections (CS) are increasing worldwide. Financial incentives and related regulatory and legislative factors are important determinants of CS rates. This scoping review examines the evidence base of financial, regulatory and legislative interventions intended to reduce CS rates.MethodsWe searched MEDLINE, EMBASE, CINAHL and two trials registers in June 2019. Both experimental and observational intervention studies were eligible for inclusion. Primary outcome measures were: CS, spontaneous vaginal and instrumental birth rates. We assessed quality of evidence using Grading of Recommendations, Assessment, Development and Evaluation (GRADE) method.ResultsWe identified 9057 articles and assessed 65 full-texts. We included 16 observational studies. Most of the studies were conducted in high-income countries. Three studies assessed payment methods for health workers: equalising physician fees for vaginal and caesarean delivery reduced CS rates in one study; however, little or no difference in CS rates was found in the remaining two studies. Nine studies assessed payment methods for health organisations: There was no difference in CS rates between diagnosis-related group (DRG) payment system compared to fee-for-service system in one study. However, DRG system was associated with lower odds for CS in another study. There was little or no difference in CS rates following implementation of global budget payment (GBP) system in two studies. Vaginal birth after caesarean section (VBAC) increased after implementation of a case-based payment system in one study. Caesarean section increased while VBAC rates decreased following implementation of a cap-based payment system in another study. Financial incentive for providers to promote vaginal delivery combined with free vaginal delivery policy was found to reduce CS rates in one study. Studied regulatory and legislative interventions (comprising legislatively imposed practice guidelines for physicians in one study and multi-faceted strategy which included policies to control CS on maternal request in another study) were found to reduce CS rates. The GRADE quality of evidence varied from very low to low.ConclusionsAvailable evidence on the effects of financial and regulatory strategies intended to reduce unnecessary CS is inconclusive given inconsistency in effects and low quality of the available evidence. More rigorous studies are needed.

Project description:Although physicians in Thailand can carry out abortions legally, unsafe abortion rates remain high and have serious consequences for women's health. Training programs for healthcare providers on the 'Care of unplanned and adolescent pregnancies for the prevention of unsafe abortions' have been implemented in Thailand with the aim of providing information and challenging negative attitudes about abortions. This study investigated the participants of the training courses in order to: (i) evaluate their knowledge and attitudes towards safe abortions; and (ii) investigate the factors that determine their knowledge and attitudes. A pre-post study design was applied. Descriptive statistics were calculated to provide an overview of the data. Bivariate analysis, a Wilcoxon signed rank test and a multivariable analysis using multiple linear regression were applied to determine the changes in attitudes and assess the likelihood of behaviour change towards adolescents and women experiencing unplanned pregnancy and abortions, according to demographic and professional characteristics. Having had the training, healthcare providers' change in attitudes towards adolescents and women experiencing unplanned pregnancies and abortions were found to be 0.67 points for the nine responses of attitudes and 0.79 points for the 14 responses on various abortion scenarios. Changes in attitude were significantly different among the varying health professional types, with non-doctors increasing by 0.53 points, non-obstetricians and non-gynaecologists increasing by 0.46 points and obstetricians and gynaecologists (OBGYN) increasing by 0.32 points. Positive attitudes towards unplanned pregnancies and unsafe abortions and attitudes towards abortion scenarios significantly increased. The career type of the health professional was a significant factor in improving attitudes. The training program was more effective among non-doctor healthcare providers. Therefore, non-doctors could be the target population for training in the future.

Dataset Information

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

Publications

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

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