Study On The Cognition And Behavior Of Cesarean Section Without Medical Indications Among Obstetricians-gynecologists

Objective:In this study,the clinical decision makers for cesarean section without medical indications(obstetricians-gynecologists)were taken as the research object.The purpose of this study was to analyze the cognition and behavior of cesarean section without medical indications among obstetricians-gynecologist from the comprehensive hospitals,and to explore the factors influencing the clinical decision making of cesarean section without medical indications for obstetricians-gynecologist,which wound provided the reference for the prevention of cesarean section without medical indications.Methods:The questionnaire of “Cognitions and behavior of cesarean section without medical indication by medical staff” was developed based on comprehensive reviews of literature,panel discussions and expert consultation.A stratified random sampling method was used in this study.Firstly,four provinces of Shanxi,Hainan,Hubei and Guangdong were randomly selected;secondly,three general hospitals were randomly selected from each province according to the hospital level.A questionnaire survey was conducted in the selected hospitals.All obstetricians and gynecologists in selected hospital were investigated with a structured self-administrated questionnaire.Finally,903 questionnaires were distributed from June 2015 to August 2016,and 884 questionnaires were responded(response rate 97.57%).Data entry was conducted with Epidata 3.0 software,data analysis was performed using SPSS 18.0 software package.The descriptive analysis was used to understand the status of cognition and behavior of cesarean section without medical indications among obstetricians and gynecologists;Chi-square test and multivariable stepwise logistic regression model were conducted to explore the influencing factors of cesarean section without medical indications.Results: 1.The cognition of cesarean section without medical indications among obstetricians-gynecologists.The average score of pros and cons of cesarean section without medical indications to maternal and neonate was 4.33(standard deviation=4.29),and 88.01% of respondents thought that the disadvantages of cesarean section without medical indications endorsed more were more than benefits for mother and neonate.67.53% of respondents had insight into the steadily rising trend of cesarean section without medical indications.Reducing the risk of medical malpractice and medical liability(49.77%),economic benefits(16.67%)and convenient arrangement of work schedule(14.25%)were the main reason for the growing trend of cesarean section.Only 58.48% of respondents reported that there were management measures to reduce the prevalence of cesarean section in their hospital.336 cases(38.01%)believed that a woman has a right to a cesarean section without medical indications.6.9% of respondents wound agree to perform a cesarean section without medical indications for maternal without a trial for vaginal delivery.However,98.15% of physicians would choose a vaginal delivery for themselves or their partners at 39 weeks of gestation,first presentation and without any other complications.2.The behavior of cesarean section without medical indications among obstetricians-gynecologist.75.11% of respondents reported that they had ever experienced cesarean section without medical indications.31.03% of respondents reported that 30% to 40% of newborn they performed were by cesarean section in the recent year,and 42.93% of respondents reported that be equal or more than 15% of the cesarean section they performed were without medical indications in the recent year.Majority of respondents(92.39%)were more likely to introduce the risks and complications when patients required for nonmedical indicated cesarean delivery.3.Study on the influencing factors for cesarean section without medical indications.The multivariate stepwise logistic regression analysis was performed by using the proportion of cesarean section without medical indications among cesarean section as the dependent variable and selecting these variables that were significant in univariate analysis as independent variables.The results showed that the educational level,the knowledge of pros and cons and the measures decreasing the prevalence of cesarean section taken by hospitals were the significantly associated with the implementation of non-medical indications cesarean section.Comparing with the master degree and above,the odds ratio(OR)for the implementation of non-medical indications of cesarean section among obstetricians-gynecologists were 1.757(95%CI: 1.255-2.460)for bachelor degrees and 2.685(95%CI: 1.738-4.150)for college degree and below,respectively;the OR of the implementation of non-medical indications of cesarean section among obstetricians-gynecologists were 1.893(95%CI: 1.237-2.895)for those that thought cesarean section without medical indications was with much more advantages for mothers and children.The risk of the implementation of non-medical indications of cesarean section among obstetricians-gynecologists was lower(OR=0.611,95%CI: 0.460-0.812)in hospitals with measures of decreasing the prevalence of cesarean section than their counterparts.Conclusions:Obstetrician-Gynecologists were with correct recognitions of the pros and cons of cesarean section without medical indications to maternal and neonate and the growing trend of cesarean section without medical indications with years,however,the percentage of implementation of cesarean section without medical indications were higher.Avoiding the medical risks and pursing economic benefits were two main reasons leading to the increased rate of cesarean section.Measures of decreasing the prevalence of cesarean section taken by hospitals were lacking.Educational level,the knowledge of pros and cons and the measures decreasing the prevalence of cesarean section taken by hospitals were the significantly associated with the portion of implementation of cesarean section without medical indications.Therefore,the appropriate rate of cesarean section is needed,and the government should further play the role of policy guidance.In addition,improving the doctor-patient relationship,establishing and perfecting medical liability insurance system,and increasing investment in medical resources;strengthening the management of cesarean section in hospitals and establishing long-term assessment mechanism were also needed,so as to effectively regulate the clinical decision making behavior of cesarean section without medical indications for obstetricians and gynecologists.