Why obstetricians choose c sections

If this were true, C-section rates would be even higher than they are now. What we are arguing is that medical care is complex and labor management is subject to myriad pressures.

While we may not be able to alleviate all the pressures at play, we may be able to reform one of them. One simple approach is to lower the C-section payment, raise the vaginal-birth payment, and meet in the middle. So we propose an alternative: Raise the payment rate for vaginal births to the C-section rate, and leave the C-section rate where it is. Policy makers will object that this method is expensive. Medical costs in the U. Simply paying more for something risks making that problem worse.

What this argument misses, though, is that the public will get much of its money back—possibly quite a lot of it. Using Health Analytics data, which covers both Medicaid births and commercial-insurance births , we found that if insurers raised the vaginal-birth reimbursement rate to the level of the C-section rate and changed nothing else, costs would rise by about 1.

Read: How one hospital reduced unnecessary C-sections. But something else would change: Namely, the C-section rate would go down. Using data from one study on blended-payment approaches and one on differences across patients , we expect that the rate would go down by about three percentage points in the short run.

Numerous studies have been conducted exploring the perceptions of various stakeholders, including maternity care providers obstetricians and midwives , pregnant women, and the general public, on the involvement of women in making decisions on a cesarean section as the mode of birth in uncomplicated pregnancies. However, there is no literature review that gives an overall picture of this controversial phenomenon in maternity care. The purpose of this literature review is to explore the decision of women with low-risk pregnancies to undergo a cesarean section as the mode of birth from the views of different stakeholders.

The results will provide a clear and comprehensive picture of these views and their implications for maternity services. The year was selected as the starting year for the search of relevant published articles because the American College of Obstetricians and Gynecologists had published a Committee Opinion statement in [ 3 ]. An author search and hand search of the reference lists of the included literature uncovered three additional papers.

A total of articles were identified. After duplicates were removed and titles and abstracts were screened, articles remained. The articles were then retrieved and read carefully to identify those eligible for inclusion in the review.

Excluded were studies involving women who had previously undergone a CS, or women with medical indications for CS during the antenatal or intrapartum period.

Only 39 articles met the criterion for inclusion, of focusing on views surrounding decision-making around the MOB in uncomplicated pregnancies. In the end, 55 articles were included in this review. The procedures for selecting the studies for this review are presented in Fig. Checklists from the National Institute of Clinical Excellence NICE were utilized to assess the quality of the qualitative or quantitative articles that were included [ 4 ].

The checklists include frameworks for assessing the population, design, validity, bias, and reliability of a study. The Quality Appraisal Checklist for Quantitative Studies was used to assess the included quantitative studies and the quantitative portion of the mixed-methods studies Additional file 1 : Table S1. Most of the studies had a representative population and a sound study method, but in the data analysis section not many used multiple explanatory analysis.

Since all were descriptive studies, none included follow-ups or comparison interventions. The Qualitative Apprasial Checklist for Qualitative Studies was used to assess the included qualitative studies and the qualitative portion of the mixed-methods studies Additional file 1 : Table S2. Most of the studies had a sound study design and relevant findings.

However, many did not include an explanation of the theoretical approach that was used to guide the study or details on how the data were anlayzed, thus raising the question of the whether the analysis was rigorous. The opinion papers were not subjected to a quality evaluation. The opinion-based papers were all authored by influential healthcare professionals who were faculty members in schools of medicine, nursing, and midwifery, and all were retained in this review.

The included literature showed that those stakeholders who had an interest in and expressed an opinion on the issue of women having an autonomous choice on whether to undergo a cesarean section included maternity care providers MCPs , pregnant women, and the general public.

Among the 55 reports included in this review, 18 research articles reported only the views of MCPs, and another 2 included the views of both MCP and pregnant women, and one included the views of both MCP and the public. A total of 14 focused on the views of pregnant women, and 4 on those of the general public. The remaining papers consisted of 16 opinion papers written by professionals. Nine out of the 21 studies 15 quantitative and 6 qualitative studies reported the views of obstetricians or obstetric trainees, and 2 studied the views of midwives.

One was conducted in eight different countries in Europe. The 15 quantitative studies included a total of obstetricians, midwives, and multidisciplinary health professionals the professionals included obstetricicans, midwives, and anesthetists, but they were not separately identified in these studies.

The largest sample, consisting of obstetricians, was from a study conducted in eight countries in Europe [ 5 ]. These qualitative studies explored the views of health professionals on why women requested a CS, and how information was provided that did or did not support the decision made by the women. In all of the included studies, the MCPs were asked if they supported the autonomous choice of a cesarean section per maternal request CSMR or would agree to perform a CS upon request.

The studies revealed that MCPs generally supported the involvement of women in making decisions throughout their pregnancy. Obstetricians were the most supportive of CSMRs, but this varied across countries. Among the registered fellows of the Maine branch of the American College of Obstetricians and Gynecologists [ 3 ], In Australia, In the US, It is interesting to note that while The reverse situation was reported in Turkey, where not as many of the obstetricians agreed with freedom of choice for women on MOB Gender differences were noted between male and female obstetricians in their support for CSMRs [ 8 , 12 ].

A similar difference was found in Italy, where Experience also seemed to have a bearing on whether obstetricians were willing to perform a CSMR.

The obstetricians involved rationalized that if complications were to occur during a birth, they would be queried on why a CS had not been performed, and could subsequently become involved in a lawsuit. The obstetricians considered the CS to be a convenient scheduled procedure, one that was less likely to attract litigation, while also generating more income. As a result, when women requested a CS, the obstetricians would provide the woman with a description of the benefits and potential complications of undergoing a CS, and allow them to make the decision [ 14 ].

In Africa, Studies were conducted on the views of healthcare professionals on the right of pregnant woman to choose a cesarean section as the mode of birth. A study of female healthcare workers in Turkey, including nurses, doctors, and hospital employees, reported that nearly one-third The differences between the views of the various female healthcare workers were not reported in the study. The midwives stated that while they agreed that women should be allowed to choose the MOB, it is the duty of midwives to provide information to guide the women in the direction of choosing what midwives perceive to be the safest MOB [ 19 , 20 , 21 , 22 , 23 ].

Maternity care providers were reported to have a tendency to recommend to women the MOB that is consistent with their own personal preference [ 11 ]. They also gave women descriptions of the birth process that were consistent with their own personal opinion [ 14 ]. These MCPs reported that they were satisfied with the birth process that they had personally undergone, and would recommend the same to others. Studies indicate that there are variations in the personal preferences of MCPs towards CS across different countries.

In China, In Denmark, However, nine of these articles also recommended that obstetricians need to exercise caution before agreeing to a CSMR. These authors took the position that although women should have the right to choose their MOB, many cannot do so as they are shouldering responsibility for themselves and the baby [ 28 ]. In summary, although the majority of obstetricians supported the concept of CSMR, they felt that a CSMR should only be performed after attempts have been made to establish that a CS is indeed a suitable choice for the individual.

The discussions in these opinion papers ranged from the issue of the autonomy of women at the individual level to the appropriate use of available resources at the system level.

It was emphasized that comprehensive informed consent cannot realistically be achieved because the evidence is lacking to support either MOB as superior [ 34 , 35 ].

The debate is not simply about the rights of women, but also about the demands on the health service system [ 36 , 37 ]. As a result there are conflicting opinions on CSMRs, depending on whether obstetricians prioritize the free choice of the individual or highlight health service resource limitations in the debate on CSMRs.

These organizations have clear recommendations and guidelines for obstetricians on CSMRs, including on the need to give a comprehensive explanation and counseling based on the most up-to-date evidence available for women who request a CS.

Once counseling has been provided, if the CS request is maintained and informed consent has been obtained, it is considered reasonable to perform the CSMR [ 4 , 38 , 40 , 41 ]. However, as there is no mechanism to monitor the implementation, whether practicing obstetricians are adhering to these recommendations is unknown. There were 16 studies nine quantitative, five qualitative, and two mixed-methods studies examining the views of pregnant women on different modes of birth, with 14 focusing solely on pregnant women, and two on pregnant women and MCPs.

There were a total of women in the quantitative studies. A total of The qualitative studies included interviews with a total of women, most from Western countries. The majority of the studies reported that women wanted to have the freedom to choose their MOB. Contradictory findings were noted within the same studies on whether the decision on a CS should be made autonomously by the pregnant woman or be the responsibility of her obstetrician.

Another study revealed that Indeed, the findings of the qualitative studies revealed that the majority of women believed that the decision on a CS should be made by obstetricians. Three qualitative studies and the qualitative section of a mixed-methods study conducted in Scotland, the UK, Australia, and Argentina [ 19 , 22 , 48 , 50 ] reported that pregnant women sought to make the decision together with their obstetricians, rather than on their own. Whether women actually made an autonomous decision on MOB was explored in the studies.

Women described being autonomous in their decision on MOB [ 19 , 52 ]. Women who perceived that they had made an autonomous decision indicated higher levels of satisfaction with their birth [ 52 ].

However, statements made by women about the process of making a decision on their MOB, showed that the women had followed the advice of their obstetrician [ 19 ]. These women said that, based on the advice of their obstetrician, they had chosen to undergo a CS because of the predictability and safety of the procedure for their baby and themselves, and that a VB involved unknown risks and unexpected outcomes. Pregnant women who choose a vaginal delivery are not officially warned about the possibility of bad outcomes for themselves or their babies.

The medical evidence is on their side. Planned C-sections are the safest option for the baby, because they avoid any chance of brain damage from a vaginal birth and the not-insignificant risk of stillbirth after 39 weeks.

A planned C-section is also the only guaranteed way to avoid a risky emergency C-section. Updated visitor guidelines. Top of the page. Topic Overview In the past 40 years, the rate of cesarean C-section deliveries has jumped from about 1 out of 20 births to about 1 out of 3 births. What is a C-section? A C-section is the delivery of a baby through a cut incision in the mother's belly and uterus. These problems might include: Labor that slows or stops. High blood pressure or other problems for the mother.

Signs of distress in the baby. These signs may include a very fast or slow heart rate. Why would a C-section be planned for personal reasons? Some women have personal reasons for wanting a C-section. They may worry that their pain won't be controlled. They may be concerned that labor will cause pelvic floor problems, such as incontinence. They may worry about vaginal tearing during delivery. They want to be sure that their own doctor delivers the baby, rather than an on-call doctor.