Shtainmetz Noa, Tesler Riki, Sharon Cochava, Korn Liat
Department of Health Systems Management, School of Health Sciences, Ariel University, Ariel, Israel.
The Academic College of Law and Science, Hod Hasharon, Israel.
SAGE Open Med. 2024 Mar 25;12:20503121241237447. doi: 10.1177/20503121241237447. eCollection 2024.
In recent decades, caesarean section rates have increased dramatically worldwide and the reasons for this trend are not fully understood. This continuing trend has raised public health concerns regarding higher maternal and perinatal risks, high costs, healthcare efficiency, and inequality of services. The current study aimed to explore the perspectives and insights of healthcare providers and policymakers in the Israeli health system regarding the factors that drive caesarean section rates and the readiness and feasibility of implementing the Robson Ten Group Classification System for the first time.
Semi-structured interviews were conducted ( = 12) with purposefully selected healthcare providers and policymakers in Israel. Data was analysed inductively using a thematic analysis approach.
The findings reflected the "changing landscape" in childbirth practices and attitudes that contributes to the rising caesarean section rate, including childbirth at older ages, birth planning, and a transition toward a more collaborative decision-making approach to childbirth. The participants emphasized the lack of a standardized classification or consistent data monitoring of caesarean section in the Israeli health system. Additionally, enablers to implement the Robson Ten Group Classification System in Israel (ease of use, data collection and recording, and the allocation of resources and personnel), as well as barriers (concerns over workload, limited resources, budget implications, and technological complexity), were found.
This study revealed the multifaceted factors shaping caesarean section rates within Israel and underscored the perceived need for evidence-based monitoring and informed decision-making in healthcare practices. Our findings support the conclusion that empirical evidence and clear data are crucial for effective caesarean section use and are currently lacking in Israeli hospitals. Thus, it is recommended to adopt a globally standardized, accepted, and effective tool-the Robson Ten Group Classification System-to accommodate the "changing landscape" in alignment with evolving medical and societal dynamics, which consequently will assist in optimizing caesarean section use.
近几十年来，全球剖宫产率急剧上升，而这一趋势的原因尚未完全明了。这种持续的趋势引发了对孕产妇和围产期更高风险、高成本、医疗保健效率以及服务不平等的公共卫生担忧。本研究旨在探讨以色列医疗系统中医疗服务提供者和政策制定者对于推动剖宫产率上升的因素以及首次实施罗布森十组分类系统的准备情况和可行性的观点与见解。
对以色列精心挑选的医疗服务提供者和政策制定者进行了12次半结构化访谈。采用主题分析方法对数据进行归纳分析。
研究结果反映了分娩实践和态度方面的“不断变化的格局”，这导致了剖宫产率的上升，包括高龄分娩、生育计划以及向更具协作性的分娩决策方式的转变。参与者强调以色列医疗系统中缺乏剖宫产的标准化分类或一致的数据监测。此外，还发现了以色列实施罗布森十组分类系统的促进因素（易用性、数据收集与记录以及资源和人员分配）以及障碍（对工作量的担忧、资源有限、预算影响和技术复杂性）。
本研究揭示了影响以色列剖宫产率的多方面因素，并强调了在医疗实践中基于证据的监测和明智决策的必要性。我们的研究结果支持这样的结论，即实证证据和清晰的数据对于有效使用剖宫产至关重要，而以色列医院目前缺乏这些。因此，建议采用一种全球标准化、被认可且有效的工具——罗布森十组分类系统——以适应与不断演变的医学和社会动态相一致的“不断变化的格局”，从而有助于优化剖宫产的使用。
