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Abstract
Objectives To explore obstetricians’, midwives’ and trainees’ perceptions of caesarean section (CS) determinants in the context of public obstetric care services provision in Argentina. Our hypothesis is that known determinants of CS use may differ in settings with limited access to essential obstetric services.
Setting We conducted a formative research study in 19 public maternity hospitals in Argentina. An institutional survey assessed the availability of essential obstetric services. Subsequently, we conducted online surveys and semistructured interviews to assess the opinions of providers on known CS determinants.
Results Obstetric services showed an adequate provision of emergency obstetric care but limited services to support women during birth. Midwives, with some exceptions, are not involved during labour. We received 680 surveys from obstetricians, residents and midwives (response rate of 63%) and interviewed 26 key informants. Six out of 10 providers (411, 61%) indicated that the use of CS is associated with the complexities of our caseload. Limited pain management access was deemed a potential contributing factor for CS in adolescents and first-time mothers. Providers have conflicting views on the adequacy of training to deal with complex or prolonged labour. Obstetricians with more than 10 years of clinical experience indicated that fear of litigation was also associated with CS. Overall, there is consensus on the need to implement interventions to reduce unnecessary CS.
Conclusions Public maternity hospitals in Argentina have made significant improvements in the provision of emergency services. The environment of service provision does not seem to facilitate the physiological process of vaginal birth. Providers acknowledged some of these challenges.
- maternal medicine
- public health
- organisation of health services
Data availability statement
Data are available on reasonable request. The data will be stored on CEDES’ server, encrypted. CEDES will be the guardian of the dataset. Dataset is available on reasonable request. Data are anonymised. Our data collection forms do not include any variable that could reveal the identity of the participants or that potentially could identify the participant institutions.
This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
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Data availability statement
Data are available on reasonable request. The data will be stored on CEDES’ server, encrypted. CEDES will be the guardian of the dataset. Dataset is available on reasonable request. Data are anonymised. Our data collection forms do not include any variable that could reveal the identity of the participants or that potentially could identify the participant institutions.
Footnotes
Contributors All authors participated in developing this project protocol. SR was responsible for the scientific aspects of the project, coordinating the team, protocol development, as well as for writing and reviewing the final version of the original protocol. APB was responsible for the revision of the protocol and for technical assistance regarding the design and methodology. She also obtained the funding for the project. MR, CP and YS were responsible for assisting the writing of the protocol and developing the versions of the instruments. NR and CG contributed to the development of the instruments and coordinated field work. CP, MR and YS contributed to the writing of the article and reviewed the final version. All authors provided feedback and revised the manuscript. The following authors were responsible for specific components of the project: SR wrote the first version of the study protocol and, together with MR, CP and YS, coordinated its development and approved the final version. CP contributed to the design of the methodology and analysis of the project. MR contributed to the methodology, the design of the fieldwork. YS contributed to literature revision. YS, CS, CG and NR conducted the semistructured interviews. CS and MR conducted the semistructured interviews analysis. CP is the guarantor of this research work. All authors read and approved the final manuscript.
Funding This research was funded by the UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), a cosponsored programme executed by the WHO in the Department of Sexual and Reproductive Health and Research. WHO Project Number A65919. CP also received funds to complete this research from the University College Dublin, College of Health Sciences, SEED Fund (2019) Grant number SF1735. NR is a research fellow funded by the Ministry of Health, Buenos Aires City Government.
Disclaimer The study design; the collection, analysis and interpretation of the data; the writing of the report and the decision to submit the paper for publication are solely the responsibility of the authors and do not reflect the views of the referred programprogramme or the other funding institutions. All authors had full access to all the data and accept responsibility to submit for publication.
Competing interests None declared.
Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.
Provenance and peer review Not commissioned; externally peer reviewed.