Abstract
The Caesarean section rate in urban Vietnam is 43% in 2014, which is more than twice the recommended rate (10%–15%) by the World Health Organization. This qualitative study aims to identify the perceptions of pregnant mothers and health care professionals on the medical and social factors related to the increased Caesarean section rate in Vietnam. A qualitative descriptive study was conducted among pregnant mothers and healthcare professionals at two public hospitals in Nha Trang city. A content analysis was adopted in order to identify social and medical factors. As a result, 29 pregnant women and 19 health care professionals were invited to participate in the qualitative interviews. Private interviews were conducted with 10 women who wished to have a Caesarean section, and the others participated in focus group interviews. The main themes of the social factors were ‘request for Caesarean section,’ ‘mental strain of obstetricians,’ and ‘decision-making process.’ To conclude, this qualitative study suggests that there were unnecessary caesarean sections without a clear medical indication, which were requested by women and family members. Psychological fear occurred among women and family, and doctors were the main determinants for driving the requests for Caesarean section, which implies that education and emotional encouragement is necessary by midwives. In addition, a multi-faced approach including a mandatory reporting system in clinical fields and involving family members in antenatal education is important.
Highlights
The concept of too little, too late (TLTL) and too much, too soon (TMTS) was first introduced by Miller et al [1], describing two groups of medical problems in the world
Ten pregnant women who requested a Caesarean section (CS) birth were asked to participate in a private interview in order to guarantee their privacy, whereas the others were enrolled in focus group interviews
Requesting CS may be induced by the belief that CS is superior to vaginal childbirth, spiritual belief for determining the auspicious date of birth, improved economic status, and an increased number of private hospitals
Summary
The concept of too little, too late (TLTL) and too much, too soon (TMTS) was first introduced by Miller et al [1], describing two groups of medical problems in the world. TMTS refers to the ‘over-medicalization of normal antenatal, intrapartum, and postnatal care’, which is mainly seen in middle-income countries (MICs) [1]. Due to misunderstanding and lack of knowledge among mothers and family. Improvement of operative care replaced instrumental delivery (forceps or vacuum) to CS in modern Vietnam. Fear of vaginal childbirth was often accompanied by concern about older age, and/or lack of self-efficacy for childbirth. Some of the pregnant women requested a CS because they were not confident about giving vaginal birth due to lack of energy, or concerned higher risk of delivery complications due to older age. Even younger pregnant mothers expressed they were not confident about giving vaginal birth
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