Who indicates caesarean section? A cross-sectional survey in a tertiary level maternity on patients and doctors’ profiles at childbirth

Abstract

Introduction. Given how common caesarean section (C-section) has become, our objectives are: 1) to analyze the way Romanian women want to give birth, and 2) to draw a profile of patients and doctors in whose case the actual birth method has changed from the preferred method after admission in the labor ward. Materials and method. We conducted a statistical analysis based on an observational, analytical and cross-sectional survey in a tertiary level maternity from Romania. Results. We calculated an increase of almost 58% in the actual childbirth mode against preferred childbirth by caesarean section, rather difficult to justify based only on medical emergencies. 31.8% preferred natural birth, and 68.2% preferred C-section. The profiles of patients with concordant and nonconcordant delivery modes are different and indicate a statistically significant difference between the preference for delivery and the actual birth method. Doctors’ profiles show that specialists and consultants attend the largest share of nonconcordant births, while residents and young senior doctors attend mostly vaginal births. Conclusions. We emphasize health system particularities in Romania as triggers of high C-section rates that favor women’s preferences against C-section medical indication. Improving patients’ confidence in the healthcare system, built on competence and fitted hierarchical team position, may lead to choosing the optimal way of birth for childbirth safety and pain control.