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The determinants of obstetricians’ willingness to undertake delivery by vaginal birth after cesarean section in Taiwan

BACKGROUND: Babies are sometimes delivered by cesarean section (CS) to women eligible for trial of labor after a cesarean (TOLAC) due to a fear of complications during the delivery process. This view is especially widespread in Taiwan, as evidenced by the extremely low rate (<5%) of vaginal birth...

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Autores principales: Linn, George, Ying, Yung-hsiang, Chang, Koyin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dove 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6698175/
https://www.ncbi.nlm.nih.gov/pubmed/31496714
http://dx.doi.org/10.2147/TCRM.S205009
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author Linn, George
Ying, Yung-hsiang
Chang, Koyin
author_facet Linn, George
Ying, Yung-hsiang
Chang, Koyin
author_sort Linn, George
collection PubMed
description BACKGROUND: Babies are sometimes delivered by cesarean section (CS) to women eligible for trial of labor after a cesarean (TOLAC) due to a fear of complications during the delivery process. This view is especially widespread in Taiwan, as evidenced by the extremely low rate (<5%) of vaginal birth after cesarean section (VBAC). To improve the safety and quality of childbirth and the obstetrical practice environment, this study aimed to identify ways to contain the ever-increasing rate of CS by investigating the determinants for TOLAC from the viewpoint of obstetricians. METHODS: A specially designed questionnaire was employed that incorporated the perceived risk of VBAC, institutional managerial attitude, and obstetricians’ personal characteristics. Face-to-face surveys were conducted with obstetricians from across Taiwan. Regression analysis was used as appropriate. RESULTS: Among the 231 recruited obstetricians, 86.7% were willing to undertake VBAC, but only 71.4% had actually done so. Obstetricians with a more risk-tolerant personality were more likely to undertake VBAC. Institutional characteristics, such as the time it takes to transfer a woman from the delivery table to the operating table (table to table) and the general facilities of the hospital to handle delivery complications resulting from VBAC were also key determinants for attempting VBAC. CONCLUSION: In Taiwan, a country with a low birthrate, obstetricians need to be risk-tolerant to undertake VBAC. This phenomenon is probably due to underinvestment in facilities for vaginal delivery and thus a general perception that VBAC is risky. The study’s results will potentially help medical institutions to adopt appropriate guidelines and build incentive structures to achieve a higher VBAC rate.
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spelling pubmed-66981752019-09-06 The determinants of obstetricians’ willingness to undertake delivery by vaginal birth after cesarean section in Taiwan Linn, George Ying, Yung-hsiang Chang, Koyin Ther Clin Risk Manag Original Research BACKGROUND: Babies are sometimes delivered by cesarean section (CS) to women eligible for trial of labor after a cesarean (TOLAC) due to a fear of complications during the delivery process. This view is especially widespread in Taiwan, as evidenced by the extremely low rate (<5%) of vaginal birth after cesarean section (VBAC). To improve the safety and quality of childbirth and the obstetrical practice environment, this study aimed to identify ways to contain the ever-increasing rate of CS by investigating the determinants for TOLAC from the viewpoint of obstetricians. METHODS: A specially designed questionnaire was employed that incorporated the perceived risk of VBAC, institutional managerial attitude, and obstetricians’ personal characteristics. Face-to-face surveys were conducted with obstetricians from across Taiwan. Regression analysis was used as appropriate. RESULTS: Among the 231 recruited obstetricians, 86.7% were willing to undertake VBAC, but only 71.4% had actually done so. Obstetricians with a more risk-tolerant personality were more likely to undertake VBAC. Institutional characteristics, such as the time it takes to transfer a woman from the delivery table to the operating table (table to table) and the general facilities of the hospital to handle delivery complications resulting from VBAC were also key determinants for attempting VBAC. CONCLUSION: In Taiwan, a country with a low birthrate, obstetricians need to be risk-tolerant to undertake VBAC. This phenomenon is probably due to underinvestment in facilities for vaginal delivery and thus a general perception that VBAC is risky. The study’s results will potentially help medical institutions to adopt appropriate guidelines and build incentive structures to achieve a higher VBAC rate. Dove 2019-08-13 /pmc/articles/PMC6698175/ /pubmed/31496714 http://dx.doi.org/10.2147/TCRM.S205009 Text en © 2019 Linn et al. http://creativecommons.org/licenses/by-nc/3.0/ This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php).
spellingShingle Original Research
Linn, George
Ying, Yung-hsiang
Chang, Koyin
The determinants of obstetricians’ willingness to undertake delivery by vaginal birth after cesarean section in Taiwan
title The determinants of obstetricians’ willingness to undertake delivery by vaginal birth after cesarean section in Taiwan
title_full The determinants of obstetricians’ willingness to undertake delivery by vaginal birth after cesarean section in Taiwan
title_fullStr The determinants of obstetricians’ willingness to undertake delivery by vaginal birth after cesarean section in Taiwan
title_full_unstemmed The determinants of obstetricians’ willingness to undertake delivery by vaginal birth after cesarean section in Taiwan
title_short The determinants of obstetricians’ willingness to undertake delivery by vaginal birth after cesarean section in Taiwan
title_sort determinants of obstetricians’ willingness to undertake delivery by vaginal birth after cesarean section in taiwan
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6698175/
https://www.ncbi.nlm.nih.gov/pubmed/31496714
http://dx.doi.org/10.2147/TCRM.S205009
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