PDF(Pubmed)
Abstract：
BACKGROUND: Globally, studies illustrate different approaches among health care professionals to decision making about caesarean section (CS) and that attitudes regarding the extent to which a CS on maternal request (CSMR) can be granted vary significantly, both between professionals and countries. Absence of proper regulatory frameworks is one potential explanation for high CSMR rates in some countries, but overall, it is unclear how recommendations and guidelines on CSMR relate to CSMR rates. In Sweden, CSMR rates are low by international comparison, but statistics show that the extent to which maternity clinics perform CSMR vary among Sweden\'s 21 self-governing regions. These regions are responsible for funding and delivery of healthcare, while national guidelines provide guidance for the professions throughout the country; however, they are not mandatory. To further understand considerations for CSMR requests and existing practice variations, the aim was to analyse guideline documents on CSMR at all local maternity clinics in Sweden.
METHODS: All 43 maternity clinics in Sweden were contacted and asked for any guideline documents regarding CSMR. All clinics replied, enabling a total investigation. We used a combined deductive and inductive design, using the framework method for the analysis of qualitative data in multi-disciplinary health research.
RESULTS: Overall, 32 maternity clinics reported guideline documents and 11 denied having any. Among those reporting no guideline documents, one referred to using national guideline document. Based on the Framework method, four theme categories were identified: CSMR is treated as a matter of fear of birth (FOB); How important factors are weighted in the decision-making is unclear; Birth contracts are offered in some regions; and The post-partum care is related to FOB rather than CSMR.
CONCLUSIONS: In order to offer women who request CS equal and just care, there is a pressing need to either implement current national guideline document at all maternity clinics or rewrite the guideline documents to enable clinics to adopt a structured approach. The emphasis must be placed on exploring the reasons behind the request and providing unbiased information and support. Our results contribute to the ongoing discussion about CSMR and lay a foundation for further research in which professionals, as well as stakeholders and both women planning pregnancy and pregnant women, can give their views on this issue.
METHODS: All 43 maternity clinics in Sweden were contacted and asked for any guideline documents regarding CSMR. All clinics replied, enabling a total investigation. We used a combined deductive and inductive design, using the framework method for the analysis of qualitative data in multi-disciplinary health research.
RESULTS: Overall, 32 maternity clinics reported guideline documents and 11 denied having any. Among those reporting no guideline documents, one referred to using national guideline document. Based on the Framework method, four theme categories were identified: CSMR is treated as a matter of fear of birth (FOB); How important factors are weighted in the decision-making is unclear; Birth contracts are offered in some regions; and The post-partum care is related to FOB rather than CSMR.
CONCLUSIONS: In order to offer women who request CS equal and just care, there is a pressing need to either implement current national guideline document at all maternity clinics or rewrite the guideline documents to enable clinics to adopt a structured approach. The emphasis must be placed on exploring the reasons behind the request and providing unbiased information and support. Our results contribute to the ongoing discussion about CSMR and lay a foundation for further research in which professionals, as well as stakeholders and both women planning pregnancy and pregnant women, can give their views on this issue.
摘要：
背景：在全球范围内，研究表明，卫生保健专业人员对剖腹产（CS）的决策采取了不同的方法，并且对产妇要求的CS（CSMR）可以被授予的程度的态度差异很大。在专业人士和国家之间。缺乏适当的监管框架是一些国家CSMR率高的一个潜在解释，但总的来说,目前尚不清楚关于CSMR的建议和指南与CSMR费率的关系.在瑞典,从国际比较来看，CSMR率很低，但统计数据显示，在瑞典的21个自治区中，妇产科诊所执行CSMR的程度各不相同。这些地区负责资助和提供医疗保健，虽然国家指导方针为全国各地的职业提供指导；然而，它们不是强制性的。为了进一步了解CSMR请求和现有实践变化的注意事项，目的是分析瑞典所有当地产科诊所关于CSMR的指南文件.
方法：联系了瑞典的所有43个妇产科诊所，并要求提供有关CSMR的任何指南文件。所有诊所都回答说，进行全面调查。我们使用了演绎和归纳相结合的设计，使用框架方法对多学科健康研究中的定性数据进行分析。
结果：总体而言，32个妇产科诊所报告了指南文件，11个否认有任何文件。在那些没有报告准则文件的人中，其中一个提到使用国家准则文件。基于框架方法，确定了四个主题类别:CSMR被视为出生恐惧(FOB);决策中的重要因素加权方式尚不清楚;某些地区提供出生合同;产后护理与FOB而不是CSMR有关.
结论：为了向要求CS的女性提供平等和公正的护理，迫切需要在所有妇产科诊所实施现行的国家指导文件，或者重写指导文件，使诊所能够采用结构化的方法。必须强调探索请求背后的原因，并提供公正的信息和支持。我们的结果有助于正在进行的关于CSMR的讨论，并为进一步的研究奠定了基础，以及利益相关者以及计划怀孕的妇女和孕妇，可以就这个问题发表自己的看法。
方法：联系了瑞典的所有43个妇产科诊所，并要求提供有关CSMR的任何指南文件。所有诊所都回答说，进行全面调查。我们使用了演绎和归纳相结合的设计，使用框架方法对多学科健康研究中的定性数据进行分析。
结果：总体而言，32个妇产科诊所报告了指南文件，11个否认有任何文件。在那些没有报告准则文件的人中，其中一个提到使用国家准则文件。基于框架方法，确定了四个主题类别:CSMR被视为出生恐惧(FOB);决策中的重要因素加权方式尚不清楚;某些地区提供出生合同;产后护理与FOB而不是CSMR有关.
结论：为了向要求CS的女性提供平等和公正的护理，迫切需要在所有妇产科诊所实施现行的国家指导文件，或者重写指导文件，使诊所能够采用结构化的方法。必须强调探索请求背后的原因，并提供公正的信息和支持。我们的结果有助于正在进行的关于CSMR的讨论，并为进一步的研究奠定了基础，以及利益相关者以及计划怀孕的妇女和孕妇，可以就这个问题发表自己的看法。
