O'Halloran Siobhan, Perlen Susan, Chapman Anna, Luba Sominsky, Dawson Samantha L, Cusworth Rachael, Alston Laura, Vasilevski Vidanka, Sweet Linda, Vuillermin Peter, Hutchinson Alison M
School of Medicine, Institute for Mental Health and Clinical Translation, Deakin University, Geelong, Victoria, Australia.
School of Nursing and Midwifery, Centre for Quality and Patient Safety, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia.
Nurs Health Sci. 2025 Sep;27(3):e70220. doi: 10.1111/nhs.70220.
Caesarean section (CS) rates are increasing globally. We aimed to understand stakeholders' perspectives on factors driving CS in pregnancy care to inform areas for intervention. Stakeholders from five health services participated in three Group Model Building workshops to identify the drivers of CS and intervention opportunities. A Causal Loop Diagram was developed to identify priority action areas. Workshop transcripts were thematically analyzed to understand the factors influencing CS rates and to identify areas for interventions to improve CS decision-making. Participants identified 29 drivers that were grouped into four priority areas for action: mothers' health and confidence, clinicians providing care, clinical monitoring and intervention, and health system issues. Five major themes emerged from the transcripts: health system issues, maternal factors, clinical factors, clinical management, and guidelines and adherence. Intervention ideas included: feedback data use across health services, improving the quality of data, and modifying data entry prompts. The factors driving CS rates related to clinicians, maternal service users, the health system, and the health service. A standardized audit and feedback tool to assess, monitor, and compare CS rates within health systems may address CS overuse.
全球剖宫产率正在上升。我们旨在了解利益相关者对孕期护理中推动剖宫产因素的看法，以为干预领域提供参考。来自五个卫生服务机构的利益相关者参加了三次群体模型构建研讨会，以确定剖宫产的驱动因素和干预机会。绘制了因果循环图以确定优先行动领域。对研讨会记录进行了主题分析，以了解影响剖宫产率的因素，并确定改善剖宫产决策的干预领域。参与者确定了29个驱动因素，这些因素被分为四个优先行动领域：母亲的健康和信心、提供护理的临床医生、临床监测和干预以及卫生系统问题。记录中出现了五个主要主题：卫生系统问题、产妇因素、临床因素、临床管理以及指南与依从性。干预想法包括：跨卫生服务机构使用反馈数据、提高数据质量以及修改数据录入提示。推动剖宫产率上升的因素与临床医生、孕产妇服务使用者、卫生系统和卫生服务有关。一种用于评估、监测和比较卫生系统内剖宫产率的标准化审计和反馈工具可能有助于解决剖宫产的过度使用问题。
