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.

Keywords: caesarean section; cesarean section/epidemiology; cesarean section/utilisation; maternal request; non-medically indicated caesarean section; obstetricians’ attitude.