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Cesarean delivery on maternal request in Israel: Maternity department policies and obstetricians’ perspectives

OBJECTIVE: This study aimed to describe Israeli maternity departments’ policies regarding cesarean delivery on maternal request, and factors associated with obstetricians’ support for cesarean delivery on maternal request in specific scenarios. METHODS: This multicenter cross-sectional study include...

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Autores principales: Hirsh-Yechezkel, Galit, Glasser, Saralee, Farhi, Adel, Levitan, Gila, Shachar, Yael, Zaslavsky-Paltiel, Inna, Boyko, Valentina, Ezra, Yossef, Lerner-Geva, Liat
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9661554/
https://www.ncbi.nlm.nih.gov/pubmed/36366970
http://dx.doi.org/10.1177/17455057221125366
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author Hirsh-Yechezkel, Galit
Glasser, Saralee
Farhi, Adel
Levitan, Gila
Shachar, Yael
Zaslavsky-Paltiel, Inna
Boyko, Valentina
Ezra, Yossef
Lerner-Geva, Liat
author_facet Hirsh-Yechezkel, Galit
Glasser, Saralee
Farhi, Adel
Levitan, Gila
Shachar, Yael
Zaslavsky-Paltiel, Inna
Boyko, Valentina
Ezra, Yossef
Lerner-Geva, Liat
author_sort Hirsh-Yechezkel, Galit
collection PubMed
description OBJECTIVE: This study aimed to describe Israeli maternity departments’ policies regarding cesarean delivery on maternal request, and factors associated with obstetricians’ support for cesarean delivery on maternal request in specific scenarios. METHODS: This multicenter cross-sectional study included 22 maternity department directors and 222 obstetricians from the majority of Israeli hospitals. Directors were interviewed and completed a questionnaire about their department’s cesarean delivery on maternal request policy, and obstetricians responded to a survey presenting case scenarios in which women requested cesarean delivery on maternal request. The scenarios represented profiles referring to the following factors: maternal age, poor obstetric history, pregnancy complications, and psychological problems. The survey also included the obstetricians’ socio-demographic information and questions about other issues associated with cesarean delivery on maternal request. The main outcome measures were department policies regarding cesarean delivery on maternal request and obstetricians’ support for cesarean delivery on maternal request in specific cases. RESULTS: Policies were divided between allowing and prohibiting cesarean delivery on maternal request (n = 10 and 12, respectively), and varied regarding issues such as informed consent and pre-surgery consultation. Most of the obstetricians (96.5%) did not support cesarean delivery on maternal request in the “reference scenario” describing a young woman with no obstetric complications. Additional factors increased the rate of support. Support was greater among obstetricians aged > 45 (odds ratio = 2.11; 95% confidence intervals 1.33–3.36) and lower among females (odds ratio = 0.58; 95% confidence intervals 0.39–0.86). Obstetricians whose department policy was less likely to allow cesarean delivery on maternal request reported lower rates of support for cesarean delivery on maternal request in most cases. CONCLUSION: Policies and obstetricians’ support for cesarean delivery on maternal request vary broadly depending on clinical profiles and physician characteristics. Department policy has an impact on obstetricians’ support for cesarean delivery on maternal request. Health policy will benefit from a framework in which the organizations, physicians, and patients are consulted.
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spelling pubmed-96615542022-11-15 Cesarean delivery on maternal request in Israel: Maternity department policies and obstetricians’ perspectives Hirsh-Yechezkel, Galit Glasser, Saralee Farhi, Adel Levitan, Gila Shachar, Yael Zaslavsky-Paltiel, Inna Boyko, Valentina Ezra, Yossef Lerner-Geva, Liat Womens Health (Lond) Original Research Article OBJECTIVE: This study aimed to describe Israeli maternity departments’ policies regarding cesarean delivery on maternal request, and factors associated with obstetricians’ support for cesarean delivery on maternal request in specific scenarios. METHODS: This multicenter cross-sectional study included 22 maternity department directors and 222 obstetricians from the majority of Israeli hospitals. Directors were interviewed and completed a questionnaire about their department’s cesarean delivery on maternal request policy, and obstetricians responded to a survey presenting case scenarios in which women requested cesarean delivery on maternal request. The scenarios represented profiles referring to the following factors: maternal age, poor obstetric history, pregnancy complications, and psychological problems. The survey also included the obstetricians’ socio-demographic information and questions about other issues associated with cesarean delivery on maternal request. The main outcome measures were department policies regarding cesarean delivery on maternal request and obstetricians’ support for cesarean delivery on maternal request in specific cases. RESULTS: Policies were divided between allowing and prohibiting cesarean delivery on maternal request (n = 10 and 12, respectively), and varied regarding issues such as informed consent and pre-surgery consultation. Most of the obstetricians (96.5%) did not support cesarean delivery on maternal request in the “reference scenario” describing a young woman with no obstetric complications. Additional factors increased the rate of support. Support was greater among obstetricians aged > 45 (odds ratio = 2.11; 95% confidence intervals 1.33–3.36) and lower among females (odds ratio = 0.58; 95% confidence intervals 0.39–0.86). Obstetricians whose department policy was less likely to allow cesarean delivery on maternal request reported lower rates of support for cesarean delivery on maternal request in most cases. CONCLUSION: Policies and obstetricians’ support for cesarean delivery on maternal request vary broadly depending on clinical profiles and physician characteristics. Department policy has an impact on obstetricians’ support for cesarean delivery on maternal request. Health policy will benefit from a framework in which the organizations, physicians, and patients are consulted. SAGE Publications 2022-11-11 /pmc/articles/PMC9661554/ /pubmed/36366970 http://dx.doi.org/10.1177/17455057221125366 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by-nc/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page(https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Original Research Article
Hirsh-Yechezkel, Galit
Glasser, Saralee
Farhi, Adel
Levitan, Gila
Shachar, Yael
Zaslavsky-Paltiel, Inna
Boyko, Valentina
Ezra, Yossef
Lerner-Geva, Liat
Cesarean delivery on maternal request in Israel: Maternity department policies and obstetricians’ perspectives
title Cesarean delivery on maternal request in Israel: Maternity department policies and obstetricians’ perspectives
title_full Cesarean delivery on maternal request in Israel: Maternity department policies and obstetricians’ perspectives
title_fullStr Cesarean delivery on maternal request in Israel: Maternity department policies and obstetricians’ perspectives
title_full_unstemmed Cesarean delivery on maternal request in Israel: Maternity department policies and obstetricians’ perspectives
title_short Cesarean delivery on maternal request in Israel: Maternity department policies and obstetricians’ perspectives
title_sort cesarean delivery on maternal request in israel: maternity department policies and obstetricians’ perspectives
topic Original Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9661554/
https://www.ncbi.nlm.nih.gov/pubmed/36366970
http://dx.doi.org/10.1177/17455057221125366
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