The effect of medical and social conditions on the mode of delivery: a prospective questionnaire-based study applied to
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MATERNAL-FETAL MEDICINE
The effect of medical and social conditions on the mode of delivery: a prospective questionnaire‑based study applied to 404 Turkish obstetricians Funda Akpinar1 · Fatih Kiliç2 · Neslihan Öztürk1 · Bora Coşkun3 · Mustafa Akşar1 · Salim Erkaya1 Received: 23 December 2019 / Accepted: 13 October 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose To identify the factors that influence provider’s decisions on method of delivery in a country where national cesarean delivery rate (CDR) among all births increased steadily from 21 to 56% in a 16-year period. Methods We planned nine birth scenarios, in which both delivery modes were plausible, and we used self-administered questionnaire to ask obstetricians for their preferred mode of delivery in these scenarios. If the choice was cesarean delivery (CD), the provider was asked to state the reason for choosing this method. We grouped respondents according to number of years in their occupation, working sector (state, university or private hospital) and academic degree. Results Four hundred and four obstetricians completed the questionnaire. Preference for CD in all scenarios was comparable between male and female obstetricians (p = 0.334) and between specialists, associate professors and professors (p = 0.812). The most frequent reason for choice of CD in all nine scenarios was fear of fetal risk and/or fear of litigation. Conclusion Fear of litigation was found to be the major factor influencing CD choice. This fear not only increases the CDR but also results in loss of training in breech delivery and operative vaginal delivery, forming a vicious cycle. Keywords Cesarean delivery · Obstetricians’ attitude · Non-medically indicated cesarean delivery · Cesarean delivery/ utilization · Cesarean delivery/epidemiology
Introduction * Funda Akpinar [email protected] Fatih Kiliç [email protected] Neslihan Öztürk [email protected] Bora Coşkun [email protected] Mustafa Akşar [email protected] Salim Erkaya [email protected] 1
Department of Obstetrics and Gynecology, University of Health Sciences Turkey, Etlik Zubeyde Hanım Women’s Health Education and Research Hospital, Ankara, Turkey
2
Department of Obstetrics and Gynecology, University of Health Sciences Turkey, Ankara City Hospital, Ankara, Turkey
3
Department of Obstetrics and Gynecology, Yuksek Ihtisas University School of Medicine, Liv Hospital, Ankara, Turkey
Cesarean delivery (CD) is a surgical operation that has all of the risks inherent to major surgery, such as injury to neighboring organs, infection of the surgical site and risks of anesthesia. Compared with vaginal birth, (CD) is associated with higher risk of uterine atony, placental invasion and insertion anomalies in following pregnancies [1]. Furthermore, there is a concern of epigenetic modifications of immunity with CD, resulting in higher incidence rates of allergies, asthma, celiac disease and type 1 diabetes in the offspring [2]. Although the att
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