Faculty of Health, School of Nursing, York University, HNES 312A, 4700 Keele Street, Toronto, Ontario, M3J 1P3, Canada.
McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L8, Canada.
BMC Pregnancy Childbirth. 2020 Jun 18;20(1):367. doi: 10.1186/s12884-020-03052-1.
Repeat caesarean sections (CSs) are major contributors to the high rate of CS in Canada and globally. Women's decisions to have a planned repeat CS (PRCS) or a trial of labour after CS (TOLAC) are influenced by their maternity care providers. This study explored factors maternity care providers consider when counselling pregnant women with a previous CS, eligible for a TOLAC, about delivery method.
A qualitative descriptive design was implemented. Semi-structured, one-to-one in-depth telephone interviews were conducted with 39 maternity care providers in Ontario, Canada. Participants were recruited at 2 maternity care conferences and with the use of snowball sampling. Interviews were audio recorded and transcribed verbatim. Data were uploaded into the data management software, NVIVO 10.0 and analyzed using qualitative content analysis.
Participants consisted of 12 obstetricians, 13 family physicians and 14 midwives. Emergent themes, reflecting the factors maternity care providers considered when counselling on mode of delivery, were organized under the categories clinical/patient factors, health system factors and provider preferences. Maternity care providers considered clinical/patient factors, including women's choice … with conditions, their assessment of women's chances of a successful TOLAC, their perception of women's risk tolerance, women's preferred delivery method, and their perception of women's beliefs and attitudes about childbirth. Additionally, providers considered health system factors which included colleague support for TOLAC and time needed to mount an emergency CS. Finally, provider factors emerged as considerations when counselling. They included provider preference for PRCS or TOLAC, provider scope of practice, financial incentives and convenience related to PRCS, past experiences with TOLAC and PRCS and providers' perspectives on risk of TOLAC.
The findings highlight the multiplicity of factors maternity care providers consider when counselling women. Effectively addressing clinical, health care system and personal factors that influence counselling may help decrease non-medically indicated PRCS.
重复剖宫产（CS）是导致加拿大和全球 CS 率居高不下的主要原因之一。女性决定进行计划性重复剖宫产（PRCS）或剖宫产术后试产（TOLAC），受到其产科医护人员的影响。本研究探讨了产科医护人员在为有既往剖宫产史、符合 TOLAC 条件的孕妇提供咨询时，考虑的影响分娩方式的因素。
采用定性描述设计。在加拿大安大略省，通过 2 次产科医护人员会议和滚雪球抽样，对 39 名产科医护人员进行了半结构式、一对一的深入电话访谈。参与者被招募，并对访谈进行了音频录制和逐字转录。数据上传到数据管理软件 NVIVO 10.0 中，并采用定性内容分析进行分析。
参与者包括 12 名产科医生、13 名家庭医生和 14 名助产士。反映产科医护人员在咨询分娩方式时考虑因素的主题，组织在以下类别下：临床/患者因素、医疗体系因素和提供者偏好。产科医护人员考虑了临床/患者因素，包括女性有条件的选择……、她们对女性成功 TOLAC 机会的评估、对女性风险承受能力的看法、女性首选的分娩方式，以及对女性对分娩的信念和态度的看法。此外，提供者还考虑了医疗体系因素，包括同事对 TOLAC 的支持以及进行紧急 CS 所需的时间。最后，提供者因素作为咨询时的考虑因素出现。它们包括提供者对 PRCS 或 TOLAC 的偏好、提供者的实践范围、PRCS 相关的经济激励和便利性、过去对 TOLAC 和 PRCS 的经验，以及提供者对 TOLAC 风险的看法。
研究结果强调了产科医护人员在咨询时考虑的多种因素。有效解决影响咨询的临床、医疗保健系统和个人因素，可能有助于减少非医学指征的 PRCS。
