School of Nursing and Midwifery, Trinity College Dublin, 2 Clare Street, D02 CK80, Dublin, Ireland.
School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin, D02 T283, Ireland.
BMC Pregnancy Childbirth. 2018 Sep 17;18(1):377. doi: 10.1186/s12884-018-2007-7.
Rising rates of caesarean section (CS) are a concern in many countries, yet Sweden has managed to maintain low CS rates. Exploring the multifactorial and complex reasons behind the rising trend in CS has become an important goal for health professionals. The aim of the study was to explore Swedish obstetricians' and midwives' perceptions of the factors influencing decision-making for CS in nulliparous women in Sweden.
A qualitative design was chosen to gain in-depth understanding of the factors influencing the decision-making process for CS. Purposive sampling was used to select the participants. Four audio-recorded focus group interviews (FGIs), using an interview guide with open ended questions, were conducted with eleven midwives and five obstetricians from two selected Swedish maternity hospitals after obtaining written consent from each participant. Data were managed using NVivo and thematically analysed. Ethical approval was granted by Trinity College Dublin.
The thematic analysis resulted in three main themes; 'Belief in normal birth - a cultural perspective'; 'Clarity and consistency - a system perspective' and 'Obstetrician makes the final decision, but...', and each theme contained a number of subthemes. However, 'Belief in normal birth' emerged as the core central theme, overarching the other two themes.
Findings suggest that believing that normal birth offers women and babies the best possible outcome contributes to having and maintaining a low CS rate. Both midwives and obstetricians agreed that having a shared belief (in normal birth), a common goal (of achieving normal birth) and providing mainly midwife-led care within a 'team approach' helped them achieve their goal and keep their CS rate low.
在许多国家，剖宫产率（CS）的上升令人担忧，但瑞典设法维持了较低的 CS 率。探索 CS 上升趋势背后的多因素和复杂原因已成为卫生专业人员的重要目标。本研究旨在探讨瑞典产科医生和助产士对影响瑞典初产妇 CS 决策因素的看法。
为了深入了解影响 CS 决策过程的因素，选择了定性设计。采用目的抽样选择参与者。在获得每位参与者的书面同意后，在两个选定的瑞典产科医院对 11 名助产士和 5 名产科医生进行了四次使用开放式问题的音频记录焦点小组访谈（FGI）。使用 NVivo 管理数据并进行主题分析。都柏林三一学院授予了伦理批准。
主题分析产生了三个主要主题：“相信正常分娩-文化视角”；“清晰和一致-系统视角”和“产科医生做出最终决定，但……”，每个主题都包含一些子主题。然而，“相信正常分娩”作为核心主题出现，涵盖了其他两个主题。
研究结果表明，相信正常分娩为妇女和婴儿提供了最佳结果有助于保持低 CS 率。助产士和产科医生都认为，共同的信念（正常分娩）、共同的目标（实现正常分娩）和在“团队方法”中提供主要的助产士主导护理有助于他们实现目标并保持低 CS 率。
