The Reasons and Strategies of High Cesarean Section Rate from Chinese Obstetricians and Midwives Perspective in the Public Hospitals: An Interpretative Phenomenologic Analysis

Abstract

Background: Despite the ever-increasing rate of Cesarean Section (CS) in China, little is known about both the reasons and strategies of high Cesarean Section Rate (CSR) from the perceptions of obstetricians and midwives, who have great influence on deciding the delivery mode. The study aims to describe obstetricians and midwives’ perceptions of the essence of the increasing CSR in the tertiary (city) and secondary (county) hospitals in China. Methods: A descriptive qualitative study design with individual interviews was used. A purposive sampling of obstetricians and midwives from the tertiary and secondary hospitals were recruited. Open-ended questions on their perceptions of high CSR were asked. Braun and Clark’s thematic analysis steps were followed for the data analysis. Results: Twelve obstetricians and fifteen midwives were interviewed. Two themes on perceptions of increasing rate of CS emerged from the in-depth interviews: The causes of CS and proposals to decrease CSR. The reasons of increasing CSR included: High-risk pregnancy and perverse labor, fear of pain in Natural Vaginal Delivery (NVD), wrong cognitions to delivery mode, women’s lack of knowledge and unmatched expectations to medical intervention, tense doctor-patient relationship, deficits of professional technique, incomplete health care system. The proposals to decrease CSR were: Strengthening prenatal education, improving professional level of health care professionals, managing labor process, strengthening hospital patient communication, managing personnel and material resources. The findings support the gap of perceptions of CS among health care professionals from different levels of hospitals. Conclusion: The obstetricians and midwives identified various reasons for the high CSR and proposed different strategies to control the high CSR.