Non-medical determinants of cesarean section in a medically dominated maternity system

Objective To assess the contribution of non‐medical factors to actual mode of delivery in a setting with high cesarean rates. Design Follow‐up survey. Setting University department of obstetrics and gynecology. Sample Women with singleton pregnancies (n = 453) where there was no awareness of medical...

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Veröffentlicht in:Acta obstetricia et gynecologica Scandinavica 2014-10, Vol.93 (10), p.1025-1033
Hauptverfasser: Dweik, Diána, Girasek, Edmond, Mészáros, Gyula, Töreki, Annamária, Keresztúri, Attila, Pál, Attila
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container_end_page 1033
container_issue 10
container_start_page 1025
container_title Acta obstetricia et gynecologica Scandinavica
container_volume 93
creator Dweik, Diána
Girasek, Edmond
Mészáros, Gyula
Töreki, Annamária
Keresztúri, Attila
Pál, Attila
description Objective To assess the contribution of non‐medical factors to actual mode of delivery in a setting with high cesarean rates. Design Follow‐up survey. Setting University department of obstetrics and gynecology. Sample Women with singleton pregnancies (n = 453) where there was no awareness of medical contradictions to vaginal delivery, attending for routine mid‐pregnancy ultrasound examination in November 2011 to March 2012, and delivering between March and August 2012. Methods Structured questionnaire completed in gestational weeks 18–22. Information on subsequent delivery was obtained from patient files and through personal contact. Main outcome measures Contribution of childbirth preference, Wijma Delivery Expectancy/Experience Questionnaire A score, socio‐demographic characteristics, attitudes toward birth issues and circumstances of pregnancy/delivery to mode of delivery. Results The majority of respondents (410/453; 90.5%) preferred vaginal delivery; nevertheless, one‐third (two‐fifths of nulliparas) had a cesarean delivery. Among nulliparous respondents, a longer perceived interval from decision for pregnancy to conception, lower importance assigned to personal control, and the presence of an obstetrician with power to decide about cesarean delivery, were independent contributors to the binary logistic regression model explaining higher maternal cesarean risks. For parous respondents, corresponding factors were younger maternal age, perceived environmental influence towards cesarean section, the respondent's belief that cesarean is more beneficial than vaginal delivery and an older obstetrician attending the delivery. Conclusions The results of this questionnaire survey contribute to the already existing evidence that against the background of high cesarean rates, non‐medical factors, as much related to the obstetricians as to pregnant women's attitudes, play an important role.
doi_str_mv 10.1111/aogs.12466
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Design Follow‐up survey. Setting University department of obstetrics and gynecology. Sample Women with singleton pregnancies (n = 453) where there was no awareness of medical contradictions to vaginal delivery, attending for routine mid‐pregnancy ultrasound examination in November 2011 to March 2012, and delivering between March and August 2012. Methods Structured questionnaire completed in gestational weeks 18–22. Information on subsequent delivery was obtained from patient files and through personal contact. Main outcome measures Contribution of childbirth preference, Wijma Delivery Expectancy/Experience Questionnaire A score, socio‐demographic characteristics, attitudes toward birth issues and circumstances of pregnancy/delivery to mode of delivery. Results The majority of respondents (410/453; 90.5%) preferred vaginal delivery; nevertheless, one‐third (two‐fifths of nulliparas) had a cesarean delivery. Among nulliparous respondents, a longer perceived interval from decision for pregnancy to conception, lower importance assigned to personal control, and the presence of an obstetrician with power to decide about cesarean delivery, were independent contributors to the binary logistic regression model explaining higher maternal cesarean risks. For parous respondents, corresponding factors were younger maternal age, perceived environmental influence towards cesarean section, the respondent's belief that cesarean is more beneficial than vaginal delivery and an older obstetrician attending the delivery. Conclusions The results of this questionnaire survey contribute to the already existing evidence that against the background of high cesarean rates, non‐medical factors, as much related to the obstetricians as to pregnant women's attitudes, play an important role.</description><identifier>ISSN: 0001-6349</identifier><identifier>EISSN: 1600-0412</identifier><identifier>DOI: 10.1111/aogs.12466</identifier><identifier>PMID: 25066090</identifier><identifier>CODEN: AOGSAE</identifier><language>eng</language><publisher>United States: Blackwell Publishing Ltd</publisher><subject>Adult ; Age Factors ; Attitude to Health ; Cesarean Section - psychology ; Cesarean Section - statistics &amp; numerical data ; Childbirth preference ; Demography ; fear of childbirth ; Female ; Humans ; Hungary ; Labor Presentation ; mode of delivery ; Parity ; Patient Participation ; Patient Preference - statistics &amp; numerical data ; Physician-Patient Relations ; Pregnancy ; principal component analysis ; Qualitative Research ; questionnaire ; Socioeconomic Factors</subject><ispartof>Acta obstetricia et gynecologica Scandinavica, 2014-10, Vol.93 (10), p.1025-1033</ispartof><rights>2014 Nordic Federation of Societies of Obstetrics and Gynecology</rights><rights>2014 Nordic Federation of Societies of Obstetrics and Gynecology.</rights><rights>Acta Obstetricia et Gynecologica Scandinavica © 2014 Nordic Federation of Societies of Obstetrics and Gynecology</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4646-d9650f63d444a3b4d0a5ab56f48d04ff8a625d724cbb4619dd97b224bd9774cc3</citedby><cites>FETCH-LOGICAL-c4646-d9650f63d444a3b4d0a5ab56f48d04ff8a625d724cbb4619dd97b224bd9774cc3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Faogs.12466$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Faogs.12466$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25066090$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Dweik, Diána</creatorcontrib><creatorcontrib>Girasek, Edmond</creatorcontrib><creatorcontrib>Mészáros, Gyula</creatorcontrib><creatorcontrib>Töreki, Annamária</creatorcontrib><creatorcontrib>Keresztúri, Attila</creatorcontrib><creatorcontrib>Pál, Attila</creatorcontrib><title>Non-medical determinants of cesarean section in a medically dominated maternity system</title><title>Acta obstetricia et gynecologica Scandinavica</title><addtitle>Acta Obstet Gynecol Scand</addtitle><description>Objective To assess the contribution of non‐medical factors to actual mode of delivery in a setting with high cesarean rates. Design Follow‐up survey. Setting University department of obstetrics and gynecology. Sample Women with singleton pregnancies (n = 453) where there was no awareness of medical contradictions to vaginal delivery, attending for routine mid‐pregnancy ultrasound examination in November 2011 to March 2012, and delivering between March and August 2012. Methods Structured questionnaire completed in gestational weeks 18–22. Information on subsequent delivery was obtained from patient files and through personal contact. Main outcome measures Contribution of childbirth preference, Wijma Delivery Expectancy/Experience Questionnaire A score, socio‐demographic characteristics, attitudes toward birth issues and circumstances of pregnancy/delivery to mode of delivery. Results The majority of respondents (410/453; 90.5%) preferred vaginal delivery; nevertheless, one‐third (two‐fifths of nulliparas) had a cesarean delivery. Among nulliparous respondents, a longer perceived interval from decision for pregnancy to conception, lower importance assigned to personal control, and the presence of an obstetrician with power to decide about cesarean delivery, were independent contributors to the binary logistic regression model explaining higher maternal cesarean risks. For parous respondents, corresponding factors were younger maternal age, perceived environmental influence towards cesarean section, the respondent's belief that cesarean is more beneficial than vaginal delivery and an older obstetrician attending the delivery. Conclusions The results of this questionnaire survey contribute to the already existing evidence that against the background of high cesarean rates, non‐medical factors, as much related to the obstetricians as to pregnant women's attitudes, play an important role.</description><subject>Adult</subject><subject>Age Factors</subject><subject>Attitude to Health</subject><subject>Cesarean Section - psychology</subject><subject>Cesarean Section - statistics &amp; numerical data</subject><subject>Childbirth preference</subject><subject>Demography</subject><subject>fear of childbirth</subject><subject>Female</subject><subject>Humans</subject><subject>Hungary</subject><subject>Labor Presentation</subject><subject>mode of delivery</subject><subject>Parity</subject><subject>Patient Participation</subject><subject>Patient Preference - statistics &amp; numerical data</subject><subject>Physician-Patient Relations</subject><subject>Pregnancy</subject><subject>principal component analysis</subject><subject>Qualitative Research</subject><subject>questionnaire</subject><subject>Socioeconomic Factors</subject><issn>0001-6349</issn><issn>1600-0412</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp90EFrHCEYBmAJLc027SU_oAi9lMKk6ujnzDEszSawJJSkyVEcdYrpjKY6Szv_Pm52k0MO9eCH8Hwv8iJ0TMkJLeebjr_yCWUc4AAtKBBSEU7ZG7QghNAKat4eovc535cXk7x5hw6ZIACkJQt0exlDNTrrjR6wdZNLow86TBnHHhuXdXI64OzM5GPAPmCN93qYsY1bPDmLx3Kn4KcZ5zlPbvyA3vZ6yO7jfh6hn2ffb5bn1fpqdbE8XVeGA4fKtiBID7XlnOu645ZooTsBPW8s4X3faGDCSsZN13GgrbWt7BjjXZmSG1MfoS-73IcU_2xcntTos3HDoIOLm6yogLqVrQRW6OdX9D5uUii_2yomGkElL-rrTpkUc06uVw_JjzrNihK1bVtt21ZPbRf8aR-56UorL_S53gLoDvz1g5v_E6VOr1bXz6HVbseXIv-97Oj0W4GspVB3lyu1BvJjeQuNuqsfAZWJmPg</recordid><startdate>201410</startdate><enddate>201410</enddate><creator>Dweik, Diána</creator><creator>Girasek, Edmond</creator><creator>Mészáros, Gyula</creator><creator>Töreki, Annamária</creator><creator>Keresztúri, Attila</creator><creator>Pál, Attila</creator><general>Blackwell Publishing Ltd</general><general>John Wiley &amp; 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numerical data</topic><topic>Physician-Patient Relations</topic><topic>Pregnancy</topic><topic>principal component analysis</topic><topic>Qualitative Research</topic><topic>questionnaire</topic><topic>Socioeconomic Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Dweik, Diána</creatorcontrib><creatorcontrib>Girasek, Edmond</creatorcontrib><creatorcontrib>Mészáros, Gyula</creatorcontrib><creatorcontrib>Töreki, Annamária</creatorcontrib><creatorcontrib>Keresztúri, Attila</creatorcontrib><creatorcontrib>Pál, Attila</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Acta obstetricia et gynecologica Scandinavica</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Dweik, Diána</au><au>Girasek, Edmond</au><au>Mészáros, Gyula</au><au>Töreki, Annamária</au><au>Keresztúri, Attila</au><au>Pál, Attila</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Non-medical determinants of cesarean section in a medically dominated maternity system</atitle><jtitle>Acta obstetricia et gynecologica Scandinavica</jtitle><addtitle>Acta Obstet Gynecol Scand</addtitle><date>2014-10</date><risdate>2014</risdate><volume>93</volume><issue>10</issue><spage>1025</spage><epage>1033</epage><pages>1025-1033</pages><issn>0001-6349</issn><eissn>1600-0412</eissn><coden>AOGSAE</coden><abstract>Objective To assess the contribution of non‐medical factors to actual mode of delivery in a setting with high cesarean rates. Design Follow‐up survey. Setting University department of obstetrics and gynecology. Sample Women with singleton pregnancies (n = 453) where there was no awareness of medical contradictions to vaginal delivery, attending for routine mid‐pregnancy ultrasound examination in November 2011 to March 2012, and delivering between March and August 2012. Methods Structured questionnaire completed in gestational weeks 18–22. Information on subsequent delivery was obtained from patient files and through personal contact. Main outcome measures Contribution of childbirth preference, Wijma Delivery Expectancy/Experience Questionnaire A score, socio‐demographic characteristics, attitudes toward birth issues and circumstances of pregnancy/delivery to mode of delivery. Results The majority of respondents (410/453; 90.5%) preferred vaginal delivery; nevertheless, one‐third (two‐fifths of nulliparas) had a cesarean delivery. Among nulliparous respondents, a longer perceived interval from decision for pregnancy to conception, lower importance assigned to personal control, and the presence of an obstetrician with power to decide about cesarean delivery, were independent contributors to the binary logistic regression model explaining higher maternal cesarean risks. For parous respondents, corresponding factors were younger maternal age, perceived environmental influence towards cesarean section, the respondent's belief that cesarean is more beneficial than vaginal delivery and an older obstetrician attending the delivery. Conclusions The results of this questionnaire survey contribute to the already existing evidence that against the background of high cesarean rates, non‐medical factors, as much related to the obstetricians as to pregnant women's attitudes, play an important role.</abstract><cop>United States</cop><pub>Blackwell Publishing Ltd</pub><pmid>25066090</pmid><doi>10.1111/aogs.12466</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record>
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subjects Adult
Age Factors
Attitude to Health
Cesarean Section - psychology
Cesarean Section - statistics & numerical data
Childbirth preference
Demography
fear of childbirth
Female
Humans
Hungary
Labor Presentation
mode of delivery
Parity
Patient Participation
Patient Preference - statistics & numerical data
Physician-Patient Relations
Pregnancy
principal component analysis
Qualitative Research
questionnaire
Socioeconomic Factors
title Non-medical determinants of cesarean section in a medically dominated maternity system
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