School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden.
Department of Public Health and Caring Sciences, Health Services Research, Uppsala University, Uppsala, Sweden.
BMC Health Serv Res. 2023 Oct 18;23(1):1117. doi: 10.1186/s12913-023-10077-7.
Globally, studies illustrate different approaches among health care professionals to decision making about caesarean section (CS) and that attitudes regarding the extent to which a CS on maternal request (CSMR) can be granted vary significantly, both between professionals and countries. Absence of proper regulatory frameworks is one potential explanation for high CSMR rates in some countries, but overall, it is unclear how recommendations and guidelines on CSMR relate to CSMR rates. In Sweden, CSMR rates are low by international comparison, but statistics show that the extent to which maternity clinics perform CSMR vary among Sweden's 21 self-governing regions. These regions are responsible for funding and delivery of healthcare, while national guidelines provide guidance for the professions throughout the country; however, they are not mandatory. To further understand considerations for CSMR requests and existing practice variations, the aim was to analyse guideline documents on CSMR at all local maternity clinics in Sweden.
All 43 maternity clinics in Sweden were contacted and asked for any guideline documents regarding CSMR. All clinics replied, enabling a total investigation. We used a combined deductive and inductive design, using the framework method for the analysis of qualitative data in multi-disciplinary health research.
Overall, 32 maternity clinics reported guideline documents and 11 denied having any. Among those reporting no guideline documents, one referred to using national guideline document. Based on the Framework method, four theme categories were identified: CSMR is treated as a matter of fear of birth (FOB); How important factors are weighted in the decision-making is unclear; Birth contracts are offered in some regions; and The post-partum care is related to FOB rather than CSMR.
In order to offer women who request CS equal and just care, there is a pressing need to either implement current national guideline document at all maternity clinics or rewrite the guideline documents to enable clinics to adopt a structured approach. The emphasis must be placed on exploring the reasons behind the request and providing unbiased information and support. Our results contribute to the ongoing discussion about CSMR and lay a foundation for further research in which professionals, as well as stakeholders and both women planning pregnancy and pregnant women, can give their views on this issue.
全球范围内的研究表明，医护人员在决定剖宫产时采用不同的方法，并且对于产妇要求剖宫产（CSMR）的范围，不同专业人员和国家的态度存在显著差异。一些国家剖宫产率较高的一个潜在原因是缺乏适当的监管框架，但总体而言，关于 CSMR 的建议和指南与 CSMR 率之间的关系尚不清楚。与国际相比，瑞典的 CSMR 率较低，但统计数据显示，瑞典 21 个自治地区的妇产科诊所执行 CSMR 的程度存在差异。这些地区负责为医疗保健提供资金和服务，而国家指南则为全国范围内的专业人员提供指导；然而，这些指南并非强制性的。为了进一步了解 CSMR 请求的考虑因素和现有实践差异，目的是分析瑞典所有妇产科诊所的 CSMR 指南文件。
联系了瑞典的 43 家妇产科诊所，并要求他们提供任何关于 CSMR 的指南文件。所有诊所都回复了，因此可以进行全面调查。我们采用了综合演绎和归纳设计，使用框架方法对多学科健康研究中的定性数据进行分析。
共有 32 家妇产科诊所报告了指南文件，11 家诊所否认有任何指南文件。在没有指南文件的诊所中，有一家参考了国家指南文件。基于框架方法，确定了四个主题类别：CSMR 被视为对分娩恐惧的问题（FOB）；决策过程中如何权衡重要因素不清楚；一些地区提供生育合同；产后护理与 FOB 有关，而不是 CSMR。
为了为要求剖宫产的女性提供平等和公正的护理，迫切需要在所有妇产科诊所实施现行的国家指南文件，或者重写指南文件，以使诊所能够采用结构化方法。必须强调的是，要探讨请求背后的原因，并提供公正的信息和支持。我们的研究结果有助于对 CSMR 的持续讨论，并为进一步的研究奠定基础，专业人员以及利益相关者和计划怀孕的女性和孕妇都可以就这一问题发表意见。
