Colomar Mercedes, Cafferata Maria Luisa, Aleman Alicia, Castellano Graciela, Elorrio Ezequiel Garcia, Althabe Fernando, Engelbrecht Susheela
Montevideo Clinical and Epidemiological Research Unit, UNICEM, Hosp Clinicas, Av Italia s/n, Montevideo, Uruguay,
Matern Child Health J. 2014 Dec;18(10):2382-92. doi: 10.1007/s10995-014-1478-z.
To explore attitudes of physicians attending births in the public and private sectors and at the managerial level toward cesarean birth in Nicaragua. A qualitative study was conducted consisting of four focus groups with 17 physicians and nine in-depth interviews with decision-makers. Although study participants listed many advantages of vaginal birth and disadvantages of cesarean birth, they perceived that the increase in the cesarean birth rate in Nicaragua has resulted in a reduction in perinatal morbidity and mortality. They ascribed high cesarean birth rates to a web of interrelated provider, patient, and health system factors. They identified five actions that would facilitate a reduction in the number of unnecessary cesarean operations: establishing standards and protocols; preparing women and their families for labor and childbirth; incorporating cesarean birth rate monitoring and audit systems into quality assurance activities at the facility level; strengthening the movement to humanize birth; and promoting community-based interventions to educate women and families about the benefits of vaginal birth. Study participants believe that by performing cesarean operations they are providing the best quality of care feasible within their context. They do not perceive problems with their current practice. The identified causes of unnecessary cesarean operations in Nicaragua are multifactorial, so it appears that a multi-layered strategy is needed to safely reduce cesarean birth rates. The recent Nicaraguan Ministry of Health guidance to promote parto humanizado ("humanization of childbirth") could serve as the basis for a collaborative effort among health care professionals, government, and consumer advocates to reduce the number of unnecessary cesarean births in Nicaragua.
为探究尼加拉瓜公共部门、私营部门及管理层中参与接生的医生对剖宫产的态度。开展了一项定性研究，包括与17名医生进行的4次焦点小组讨论以及与决策者进行的9次深度访谈。尽管研究参与者列举了顺产的诸多优点和剖宫产的缺点，但他们认为尼加拉瓜剖宫产率的上升已使围产期发病率和死亡率有所降低。他们将高剖宫产率归因于一系列相互关联的医疗服务提供者、患者及卫生系统因素。他们确定了五项有助于减少不必要剖宫产手术数量的行动：制定标准和规程；让妇女及其家人为分娩做好准备；将剖宫产率监测和审核系统纳入医疗机构层面的质量保证活动；加强人性化分娩运动；以及推动基于社区的干预措施，向妇女和家庭宣传顺产的益处。研究参与者认为，通过实施剖宫产手术，他们正在其所处环境中提供可行的最佳医疗服务质量。他们并未意识到其当前做法存在问题。尼加拉瓜不必要剖宫产手术的确定原因是多方面的，因此似乎需要采取多层次策略来安全降低剖宫产率。尼加拉瓜卫生部近期关于促进“人性化分娩”的指导意见可成为医疗保健专业人员、政府及消费者倡导者共同努力减少尼加拉瓜不必要剖宫产数量的基础。
