Reasons for performing a caesarean section in public hospitals in rural Bangladesh

BMC Pregnancy and Childbirth

Nynke van den Broek¹  Abdul Halim²  Bettina Utz¹  Mamuda Aminu¹ 

[1] Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK;Reproductive and Child Health Department, Centre for Injury Prevention and Research, Dhaka, Bangladesh

关键词: Maternal mortality;    Bangladesh;    Indications;    Caesarean section;   

Others  :  1127429
DOI  :  10.1186/1471-2393-14-130

 received in 2013-11-29, accepted in 2014-04-01,  发布年份 2014

【 摘 要 】

Background

It is estimated that 18.5 million Caesarean Sections (CS) are conducted annually worldwide and about one-third of them are done without medical indications and described as “unnecessary”. Although developed countries account for most of the rise in the trend of unnecessary CS, more studies report a similar trend in developing countries, putting a strain on existing but limited healthcare resources, jeopardizing families' financial security and presenting a barrier to equitable universal coverage. We examined indications for CS in public hospitals of one district in Bangladesh and explored factors influencing decision to perform the procedure.

Methods

Retrospective review of case notes of 530 women who had CS in 5 public hospitals in Thakurgaon District of Bangladesh. Key Informant Interviews (KII) with 18 service providers to explore factors associated with the decision to perform a CS.

Results

The commonest recorded indications for CS were: previous CS (29.4%), fetal distress (15.7%), cephalo-pelvic disproportion (10.2%), prolonged obstructed labor (8.3%) and post-term dates (7.0%). The majority (68%) of CS were performed as emergency; mainly during daytime working hours. Previous CS and “post-term dates” were common indications for elective CS with “post dates” – the commonest indication for CS in primiparous women. 16.0% of all CS were conducted for cases where alternative forms of care might have been more appropriate. Providers reported not using protocols and evidence based guidelines even though these are available. Pressure from patients and relatives to deliver by CS strongly influenced decision making. External agents from private hospitals receive a financial reward for every CS performed and are present in public hospitals to “lobby” for CS.

Conclusion

Factors other than evidence based practice or the presence of a clear medical indication influence providers’ decision to perform both elective and emergency CS in public hospitals in Bangladesh.

【 授权许可】

   
2014 Aminu et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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