Variation of caesarean section rates in Palestinian governmental hospitals.

Autor: Shalash A; Institute of Community and Public Health, Birzeit University, West Bank, State of Palestine. aashalash@birzeit.edu.; School of Medicine, University of Limerick, Limerick, Ireland. aashalash@birzeit.edu., Wahdan Y; Institute of Community and Public Health, Birzeit University, West Bank, State of Palestine., Alsalman HMM; New Jericho Hospital, West Bank, State of Palestine., Shehab AJK; Qalaqilia Hospital, West Bank, State of Palestine., Afifi T; Faculty of Medicine, Islamic University of Gaza, Gaza, State of Palestine., Nabaa HA; Continuing Education Department (PHC)/Salfit, Palestinian Ministry of Health(MOH), West Bank, State of Palestine., Sarsour I; Al Hilal Al Emarati Hospital, Gaza, State of Palestine., Jarour N; Al Hilal Al Emarati Hospital, Gaza, State of Palestine., Hamed A; Palestinian Board of Obs and Gyne, Al Bireh, State of Palestine., Abu-Rmeileh NME; Institute of Community and Public Health, Birzeit University, West Bank, State of Palestine.
Jazyk: angličtina
Zdroj: BMC pregnancy and childbirth [BMC Pregnancy Childbirth] 2022 Dec 16; Vol. 22 (1), pp. 943. Date of Electronic Publication: 2022 Dec 16.
DOI: 10.1186/s12884-022-05275-w
Abstrakt: Background: Globally, the increased use of cesarean sections has become prevalent in high-income and low and middle-income countries. In Palestine, the rate had risen from 20.3% in 2014 to 25.1% in 2018. We have rates as high as 35.8% in some governmental hospitals and some as low as 15%. This study aimed to understand better why there is a variation in cesarean rates in governmental hospitals that use the same guidelines.
Methods: A qualitative and quantitative research approach was used. In-depth interviews were conducted with 27 specialists, obstetrics and gynecologists, and midwives in five government hospitals. The hospitals were selected based on the 2017 Annual Health Report reported cesarean section rates. The interview guide was created with the support of specialists and researchers and was piloted. Questions focused mainly on adherence to the obstetric guidelines and barriers to the use, sources of information, training for healthcare providers, the hospital system, and the factors that affect decision-making. Each hospital's delivery records for one month were analyzed to determine the reason for each cesarean section.
Results: The results indicated that each governmental hospital at the system level had a different policy on cesarean sections. The National Guidelines were found to be interpreted differently among hospitals. One obstetrician-gynecologist decided on a cesarean section at high-rate hospitals, while low-rate hospitals used collective decision-making with empowered midwives. At the professional level, all hospitals urged the importance of a continuous training program to refresh the medical team knowledge, in-house training of new members joining the hospital, and discussion of cases subjective to obstetrician-gynecologists interpretations.
Conclusion: Several institutional factors were identified to strengthen the implementation of the national obstetric guidelines. For example, encouraging collective decision-making between obstetrician-gynecologists and midwives, promoting the use of a second opinion, and mandatory training.
(© 2022. The Author(s).)
Databáze: MEDLINE
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