Addressing the Increasing Rate of Caesarean Sections in an Australian Healthcare System: A Systems Science Approach to Identify Stakeholder Perspectives.

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.