Pierre K D, Vayda E, Lomas J, Enkin M W, Hannah W J, Anderson G M
Department of Health Administration, Faculty of Medicine, University of Toronto, Ontario, Canada.
Soc Sci Med. 1991;32(11):1283-9. doi: 10.1016/0277-9536(91)90044-d.
This paper describes one aspect of a research program aimed at reducing the incidence of cesarean section in Ontario for women with a previous cesarean section or a breech presentation. Using data from multiple sources--surveys of obstetricians, and hospital administrators, and hospital record statistics, the authors attempt to assess the response of obstetricians to pressure to change their practice. This pressure comes principally from the Canadian Consensus Conference Statement on Cesarean Birth, released in June 1986 and subsequently endorsed by a number of professional organizations. The Statement provides clear guidelines for the management of labour in women with previous cesarean section or a breech presentation. The findings present a number of interpretive challenges. Based on their response to hypothetical cases obstetricians are favourably disposed to considering a trial of labour for women with previous cesarean section and breech presentation. However, both their reported practices, as well as hospital statistics indicate the continued high prevalence of cesarean section, though there is a small decline in cesareans for previous cesarean section. There was no evidence that hospitals lacked appropriate facilities for a trial of labour or had unduly restricted formal policies. Furthermore, although awareness of and agreement with the Consensus Statement recommendations was high, when questioned on the actual details of the recommendations, obstetrician's recall was surprisingly low. Respondents tended to err in the direction of choosing more conservative measures than those recommended by the Statement.(ABSTRACT TRUNCATED AT 250 WORDS)
本文描述了一项研究计划的一个方面，该计划旨在降低安大略省有过剖宫产史或臀位分娩史的女性的剖宫产发生率。作者利用来自多个来源的数据——对产科医生、医院管理人员的调查以及医院记录统计数据，试图评估产科医生对改变其医疗行为的压力所做出的反应。这种压力主要来自于1986年6月发布并随后得到一些专业组织认可的《加拿大剖宫产分娩共识会议声明》。该声明为有过剖宫产史或臀位分娩史的女性的分娩管理提供了明确的指导方针。研究结果带来了一些解读上的挑战。基于他们对假设病例的反应，产科医生倾向于考虑对有过剖宫产史和臀位分娩史的女性进行试产。然而，他们报告的医疗行为以及医院统计数据都表明剖宫产的发生率仍然很高，尽管有过剖宫产史的女性的剖宫产率略有下降。没有证据表明医院缺乏试产的适当设施或过度限制了正式政策。此外，尽管对《共识声明》建议的知晓度和认同度很高，但当被问及建议的实际细节时，产科医生的记忆却出奇地差。受访者倾向于选择比声明中建议的更为保守的措施。（摘要截选至250词）
