Research Article
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Increased Cesarean-Section Birth Rates and Affecting Related Factors

Year 2021, Volume: 5 Issue: 1, 48 - 54, 23.04.2021
https://doi.org/10.30565/medalanya.793484

Abstract

Aim: The present study aims to evaluate the opinions of physicians on increased C-section delivery rates and their coping ways working at different institutions. 


Method: This descriptive, cross-sectional study included a total of 200 obstetricians and gynecologists with an experience of at least 20 years chosen through simple random sampling among registered in the Republic of Turkey, Ministry of Health da-tabase. In the questionnaire, their opinions about test exams and their opinions about solutions to decrease C-section rates were investigated.


Results: The majority of the participants (89.0%) responded “Strongly Agree” to the following item: “Factors other than medical causes may affect the decision for C-sec-tion”. Similarly, the majority of the physicians responded “Strongly Agree” to the item on the increase in C-section rates along with malpractices and social pressure put by the patient and her relatives(89.0% and 89.5%, respectively). For the majority of the participants (84.0% and 85.0%, respectively), the main suggestions to overcome the increased C-section delivery rates was to lower; social pressure put against the physicians by the patient and her relatives, and removal of malpractice penalties re-latedfor possible adverse outcomes during normal delivery. In this study, the majority of the physicians responded “Strongly Disagree” to the items related to the imposing penalties and granting bonuses (56.0% and 56.5%, respectively). Similarly, 81.0% of the physicians responded “Strongly Disagree” to the item stating that healthcare planners correctly interfere with the main cause of increased C-section rates.

Conclusions: The most important reasons for the high cesarean rates are seen as the fear of malpractice and social pressure of physicians working in both public and private sectors.

References

  • 1. Myers SA, Gleicher N. Asuccessful program to lower cesarean-section rates. N Engl J Med. 1988;319(23):15116.  doi: 10.1056/NEJM198812083192304
  • 2. World Health Organization. (‎2015)‎. WHO statement on caesarean section rates. World Health Organization.  https://apps.who.int/iris/handle/10665/161442
  • 3. Betrán AP, Ye J, Moller A-B, Zhang J, Gülmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.doi: 10.1371/journal.pone.0148343
  • 4. Santas G & Santas F. Trends of caesarean section rates in Turkey. J Obstet Gynaecol. 2018; 38(5): 658-662. doi.org/10.1080/01443615.2017.1400525
  • 5. OECD (2017), Caesareansections (indicator). doi: 10.1787/ adc3c39f-en (Accessed on 13 December 2017)
  • 6. Filiz M. Analysis of Policy for the Caesarean surgery in Turkey. Artvin Coruh University International Journal of Social Sciences. 2020; 6 (1): 74-83 . [Turkish] doi: 10.22466/acusbd.736529
  • 7. Caglayan EK, Kara M, Gürel YC. Three-year cesarean rate and indications in our clinic. J. Exp. Clin. Med. 2010;27:50-53. [Turkish] doi: 10.5835/jecm.omu.27.02.009
  • 8. Yapça ÖE, Karaca İ, Çatma T. How Can We Reduce Increasing Cesarean Rates? Evaluation with Our Three-Year Cesarean Section Data. İKSST Derg. 2015;7(3):97-102. [Turkish] doi:10.5222/iksst.2015.097
  • 9. Coskun B, Pay RE, Coskun B, Simsir C, Dur R, Colak E et al.Comparison of Emergency and Elective Cesarean Sections in the Breech Presentation: A Case-Control Study. Med J Bakirkoy. 2020;16(2):132-7. doi: 10.5222/BMJ.2020.27247
  • 10. Başkaya Y, Sayıner FD. Evidence-Based Midwifery Practices To Reduce Cesarean Rate. HSP. 2018;5(1):113-119. [Turkish] doi:10.17681/hsp.335472
  • 11. Eskicioğlu F. Evaluation of Obstetrics and Gynecology Doctors and midwives in Turkey in terms of high cesarean rate. Turkiye Klinikleri J Gynecol Obst. 2015;25(4):295-6. [Turkish] doi: 10.5336/gynobstet.2014-41308
  • 12. Esencan TY, Aslan E. Gynaecology and Obstetrics Medical Errors and Patient Safety. J Health Nurs Manag. 2015;2(3): 152-161. doi:10.5222/SHYD.2015.152
  • 13. Çakmak C, Balçık PY. Investigation with Supreme Court Decision of Malpractice Cases occuring in Deliveries with C-section. Jinekoloji-Obstetrik ve Neonatoloji Tıp Dergisi. 2019;16(3):155-159. [Turkish] https://dergipark.org.tr/tr/download/article-file/931757
  • 14. Frakes M, Gruber J. Defensive Medicine and Obstetric practices: Evidencefrom the Military Health System. Journal of Empirical Legal Studies. 2020; 17(1):4. doi: 10.1111/jels.12241
  • 15. Dubay L, Kaestner R, Waidmann T. The impact of malpractice fears on cesarean section rates. J Health Econ. 1999;18(4):491-522. doi: 10.1016/s0167-6296(99)00004-1.
  • 16. Schifrin BS, Cohen WR. The effect of malpractice claims on the use of caesarean section. Best Practice & Research Clinical Obstetrics & Gynaecology. 2013;27(2):269-83. doi: 10.1016/j.bpobgyn.2012.10.004.
  • 17. Shurtz I. The impact of medical errors on physician behavior: Evidence from malpractice litigation. J Health Econ. 2013;32(2):331-40. doi:10.1016 / j.jhealeco.2012.11.011
  • 18. Özcan NK, Bilgin H. Violence against Healthcare Service Providers in Turkey: Systematic Review. Turkiye Klinikleri Journal of Medical Sciences. 2011;31(6):1442-56.doi: 10.5336/medsci.2010-20795
  • 19. İlhan MN, Çakır M, Tunca MZ, Avcı E, Çetin E, Aydemir Ö, et al. Violence against Healthcare Service Providers through the Eyes of Society: Causes, Attitudes, Behaviours. Gazi Medical Journal. 2013;24(1):5-10. doi: 10.12996/gmj.2013.02
  • 20. Beresford EB. Uncertainty and the Shaping of Medical Decisions. The Hastings Center Report. 1991;21(4):6-11.PMID: 1938352
  • 21. Patel RS, Bachu R, Adikey A, Malik M, Shah M. Factors Related to Physician Burnout and Its Consequences: A Review. Behav Sci (Basel). 2018 Nov; 8(11): 98. doi: 10.3390/bs8110098
  • 22. Demirbaş M, Karabel MP, İnci MB. Changing the frequency of cesarean delivery and possible causes in the world and Turkey. Sakarya Tıp Dergisi. 2018;7(4):158-63. https://doi.org/10.31832/smj.368600
  • 23. Sigmund K, Hauert C, Nowak MA. Reward and punishment. Proceedings of the National Academy of Sciences. 2001;98(19):10757-62. doi: 10.1073 / pnas.161155698
  • 24. Kohlberg L,Hersh RH. Moral development: A review of the theory. Theory into Practice. 1977; 16(2):53-59. doi:10.1080/00405847709542675
  • 25. Baucus MS, Beck-Dudley CL. Designing Ethical Organizations: Avoiding the Long-Term Negative Effects of Rewards and Punishments. Journal of Business Ethics. 2005;56(4):355-70.doi:10.1007 / s10551-004-1033-8
  • 26. Erkan A. Payment based on Performance: Implementation of the Ministry of Health. Maliye Dergisi. 2011;160(423-438). [Turkish] https://ms.hmb.gov.tr/uploads/2019/09/021-1.pdf

Artmış Sezaryen-Doğum Oranları ve Etkileyen İlgili Faktörler

Year 2021, Volume: 5 Issue: 1, 48 - 54, 23.04.2021
https://doi.org/10.30565/medalanya.793484

Abstract

Amaç:Bu çalışmada farklı kurumlarda çalışan hekimlerin sezaryen doğumlardaki artış nedenleri ve çözüm yolları ile ilişkili görüşlerinin değerlendirilmesi amaçlanmıştır. 


Yöntem: Kesitsel tipte ve tanımlayıcı olarak yapılan bu araştırmada T.C. Sağlık Bakan-lığı sistemine kayıtlı ve en az 20 yıl mesleki tecrübesi olan 200 kadın hastalıkları ve doğum uzmanı hekime ulaşılarak anket uygulanmıştır. Ankette hekimlerin sezaryen oranları artışı nedenleri ile ilgili görüşleri ve sezaryen oranlarını azaltmak için çözüm yolları ile ilgili görüşleri araştırılmıştır.


Bulgular: Ankete katılan tüm hekim grubunun önemli bir kısmı (%89.0) ‘Sezaryen kararı alırken tıbbi nedenler dışında faktörler sezaryen kararını etkiler’ maddesine ‘kesinlikle katılıyorum’ yanıtını vermiştir. Benzer şekilde hekimlerin çoğunluğu ‘mal-praktis uygulamaları’ ve‘hasta ve yakınlarının yarattığı baskının’ sezaryen doğum kararını arttırdığı ilişkin görüşe kesinlikle katılmaktadır (sırasıyla %89.0 ve %89.5). Katılımcıların %85’i sezaryen oranlarındaki artışı önlemek için çözüm yolu olarak; vajinal doğumda oluşabilecek olumsuz sonuçlara ilişkin malpraktis cezalarının kaldırıl-masını,%84'ü vajinal doğumdaki olası olumsuz sonuçlar için hasta ve yakınları tarafından hekime uygulanan sosyal baskıyı azaltmayı görmektedir. Bu çalışmada hekimlerin çoğunluğu çözüm yolu olarak görülen cezalandırma veya ücret yoluyla ödüllendirme ile ilgili önerilere (sırasıyla %56.0 ve %56.5) ''kesinlikle katılmıyorum'' cevabı vermişlerdir. Yine hekimlerin %81'i sağlık planlayıcılarının sezaryen oranların-daki artışa doğru şekilde müdahale edebildiği fikrine kesinlikle katılmamaktadır. 


Sonuç: Sezaryen oranlarının yüksek seviyelerde olmasında; hem kamu hem de özel sektörde çalışan hekimler açısından malpraktis korkusu ve sosyal baskı en önemli nedenler olarak görülmektedir. 

References

  • 1. Myers SA, Gleicher N. Asuccessful program to lower cesarean-section rates. N Engl J Med. 1988;319(23):15116.  doi: 10.1056/NEJM198812083192304
  • 2. World Health Organization. (‎2015)‎. WHO statement on caesarean section rates. World Health Organization.  https://apps.who.int/iris/handle/10665/161442
  • 3. Betrán AP, Ye J, Moller A-B, Zhang J, Gülmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.doi: 10.1371/journal.pone.0148343
  • 4. Santas G & Santas F. Trends of caesarean section rates in Turkey. J Obstet Gynaecol. 2018; 38(5): 658-662. doi.org/10.1080/01443615.2017.1400525
  • 5. OECD (2017), Caesareansections (indicator). doi: 10.1787/ adc3c39f-en (Accessed on 13 December 2017)
  • 6. Filiz M. Analysis of Policy for the Caesarean surgery in Turkey. Artvin Coruh University International Journal of Social Sciences. 2020; 6 (1): 74-83 . [Turkish] doi: 10.22466/acusbd.736529
  • 7. Caglayan EK, Kara M, Gürel YC. Three-year cesarean rate and indications in our clinic. J. Exp. Clin. Med. 2010;27:50-53. [Turkish] doi: 10.5835/jecm.omu.27.02.009
  • 8. Yapça ÖE, Karaca İ, Çatma T. How Can We Reduce Increasing Cesarean Rates? Evaluation with Our Three-Year Cesarean Section Data. İKSST Derg. 2015;7(3):97-102. [Turkish] doi:10.5222/iksst.2015.097
  • 9. Coskun B, Pay RE, Coskun B, Simsir C, Dur R, Colak E et al.Comparison of Emergency and Elective Cesarean Sections in the Breech Presentation: A Case-Control Study. Med J Bakirkoy. 2020;16(2):132-7. doi: 10.5222/BMJ.2020.27247
  • 10. Başkaya Y, Sayıner FD. Evidence-Based Midwifery Practices To Reduce Cesarean Rate. HSP. 2018;5(1):113-119. [Turkish] doi:10.17681/hsp.335472
  • 11. Eskicioğlu F. Evaluation of Obstetrics and Gynecology Doctors and midwives in Turkey in terms of high cesarean rate. Turkiye Klinikleri J Gynecol Obst. 2015;25(4):295-6. [Turkish] doi: 10.5336/gynobstet.2014-41308
  • 12. Esencan TY, Aslan E. Gynaecology and Obstetrics Medical Errors and Patient Safety. J Health Nurs Manag. 2015;2(3): 152-161. doi:10.5222/SHYD.2015.152
  • 13. Çakmak C, Balçık PY. Investigation with Supreme Court Decision of Malpractice Cases occuring in Deliveries with C-section. Jinekoloji-Obstetrik ve Neonatoloji Tıp Dergisi. 2019;16(3):155-159. [Turkish] https://dergipark.org.tr/tr/download/article-file/931757
  • 14. Frakes M, Gruber J. Defensive Medicine and Obstetric practices: Evidencefrom the Military Health System. Journal of Empirical Legal Studies. 2020; 17(1):4. doi: 10.1111/jels.12241
  • 15. Dubay L, Kaestner R, Waidmann T. The impact of malpractice fears on cesarean section rates. J Health Econ. 1999;18(4):491-522. doi: 10.1016/s0167-6296(99)00004-1.
  • 16. Schifrin BS, Cohen WR. The effect of malpractice claims on the use of caesarean section. Best Practice & Research Clinical Obstetrics & Gynaecology. 2013;27(2):269-83. doi: 10.1016/j.bpobgyn.2012.10.004.
  • 17. Shurtz I. The impact of medical errors on physician behavior: Evidence from malpractice litigation. J Health Econ. 2013;32(2):331-40. doi:10.1016 / j.jhealeco.2012.11.011
  • 18. Özcan NK, Bilgin H. Violence against Healthcare Service Providers in Turkey: Systematic Review. Turkiye Klinikleri Journal of Medical Sciences. 2011;31(6):1442-56.doi: 10.5336/medsci.2010-20795
  • 19. İlhan MN, Çakır M, Tunca MZ, Avcı E, Çetin E, Aydemir Ö, et al. Violence against Healthcare Service Providers through the Eyes of Society: Causes, Attitudes, Behaviours. Gazi Medical Journal. 2013;24(1):5-10. doi: 10.12996/gmj.2013.02
  • 20. Beresford EB. Uncertainty and the Shaping of Medical Decisions. The Hastings Center Report. 1991;21(4):6-11.PMID: 1938352
  • 21. Patel RS, Bachu R, Adikey A, Malik M, Shah M. Factors Related to Physician Burnout and Its Consequences: A Review. Behav Sci (Basel). 2018 Nov; 8(11): 98. doi: 10.3390/bs8110098
  • 22. Demirbaş M, Karabel MP, İnci MB. Changing the frequency of cesarean delivery and possible causes in the world and Turkey. Sakarya Tıp Dergisi. 2018;7(4):158-63. https://doi.org/10.31832/smj.368600
  • 23. Sigmund K, Hauert C, Nowak MA. Reward and punishment. Proceedings of the National Academy of Sciences. 2001;98(19):10757-62. doi: 10.1073 / pnas.161155698
  • 24. Kohlberg L,Hersh RH. Moral development: A review of the theory. Theory into Practice. 1977; 16(2):53-59. doi:10.1080/00405847709542675
  • 25. Baucus MS, Beck-Dudley CL. Designing Ethical Organizations: Avoiding the Long-Term Negative Effects of Rewards and Punishments. Journal of Business Ethics. 2005;56(4):355-70.doi:10.1007 / s10551-004-1033-8
  • 26. Erkan A. Payment based on Performance: Implementation of the Ministry of Health. Maliye Dergisi. 2011;160(423-438). [Turkish] https://ms.hmb.gov.tr/uploads/2019/09/021-1.pdf
There are 26 citations in total.

Details

Primary Language English
Subjects Surgery
Journal Section Research Article
Authors

Alparslan Deniz 0000-0003-1421-9962

Publication Date April 23, 2021
Submission Date September 10, 2020
Acceptance Date November 7, 2020
Published in Issue Year 2021 Volume: 5 Issue: 1

Cite

Vancouver Deniz A. Increased Cesarean-Section Birth Rates and Affecting Related Factors. Acta Med. Alanya. 2021;5(1):48-54.

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