Abstract
China has a high cesarean delivery (CD) and low labor epidural analgesia (LEA) rate. This online survey was conducted to explore the reasons behind this phenomenon and potential solutions. A voluntary, anonymous survey was distributed via both WeChat and professional websites for 4 months amongst groups of Chinese perinatal professionals. Data was collected and analyzed using a Chi-square test and presented as percentages of respondents. 1412 respondents were recorded (43% anesthesiologists, 35% obstetricians, 15.5% midwives or labor and delivery nurses, and 6.5% others), and 1320 respondents were care providers. It was found that 82.7% (1092/1320) of the provider respondents used CD per patient request in fear of lawsuits or yinao/yibao and 63.4% (837/1320) used CD for respecting superstitious culture. The number one reason (noted by 60.2% (795/1320) of all the three specialties) for low LEA use was lack of anesthesia manpower without statistical difference among specialties. The most recommended solution was increasing the anesthesia workforce, proposed by 79.8% (1053/1320) of the three specialties. However, the top solution provided by the two non-anesthesia specialties is different from the one proposed by anesthesiologists. The later (83%, 504/606) suggested increasing the incentive to provide the service is more effective. The answers to questions related to medical knowledge about CD and LEA, and unwillingness of anesthesiologists, parturients and their family members to LEA were similar for the most part, while the opinions regarding low LEA use related to poor experiences and unwillingness of obstetricians and hospital administrators were significantly divided among the three specialties. In the providers' point of view, the unwillingness to LEA from parturient's family members was the most salient (26.1%, 345/1320), which is more than all care providers, hospital administrators, and parturients themselves (16.8%, 222/1320). The reasons for high CD rate and low LEA use are multifactorial. The sociological issues (fear of yinao/yibao and superstitious culture) were the top two contributing factors for the high CD rate in China, while lack of anesthesia manpower was the top response for the low LEA use, which contributes to its being the most recommended solution overall from the three specialties. An incentive approach to providers is a short-term solution while training more perinatal care providers (especially among anesthesiologists and midwives), improving billing systems, and reforming legal systems are 3 systemic approaches to tackling this problem in the long-term.
Highlights
The rate of cesarean delivery (CD) in China was one of the highest in the world at 46.2% in 2007 [1], 28.8% in 2008, and 34.9% in 2014 [2]
The top solution provided by the two non-anesthesia specialties is different from the one proposed by anesthesiologists
Three large impact studies with approximately 50,000 parturients spearheaded by No Pain Labor & Delivery– Global Health Initiative (NPLD-GHI) since its inception in 2008 has confirmed that implementing 24/7 labor epidural analgesia (LEA) services is correlated with lower rates of CD in 3 different settings [8,9,10]
Summary
The rate of cesarean delivery (CD) in China was one of the highest in the world at 46.2% in 2007 [1], 28.8% in 2008, and 34.9% in 2014 [2]. Many factors contribute to this high CD rate, with one of the possible reasons due to fear of labor pain [3, 4]. This is strictly independent of cultural factors and exists in up to 68% of Chinese women and 91% of Iranian women [5, 6]. Three large impact studies with approximately 50,000 parturients spearheaded by No Pain Labor & Delivery– Global Health Initiative (NPLD-GHI) since its inception in 2008 has confirmed that implementing 24/7 LEA services is correlated with lower rates of CD in 3 different settings (municipal maternal hospitals, academic institutions, and rural area hospitals) [8,9,10]. Anesthesiologists could play an important role in effectively decreasing the CD rate, given that LEA usage increased from < 1% to 31% in some hospitals or regions from 2007 to 2018 [8,9,10,11,12,13]
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have