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Reasons for performing a caesarean section in public hospitals in rural Bangladesh

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Aminu, Mamuda ORCID: https://orcid.org/0000-0002-2335-7147, Utz, Bettina, Halim, Abdul and Van Den Broek, Nynke ORCID: https://orcid.org/0000-0001-8523-2684 (2014) 'Reasons for performing a caesarean section in public hospitals in rural Bangladesh'. BMC Pregnancy and Childbirth, Vol 14, Issue 1, e130.

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Abstract

Background
It is estimated that 18.5 million Caesarean Sections (CS) are conducted annually worldwide and about one-third of them are done without medical indications and described as “unnecessary”. Although developed countries account for most of the rise in the trend of unnecessary CS, more studies report a similar trend in developing countries, putting a strain on existing but limited healthcare resources, jeopardizing families' financial security and presenting a barrier to equitable universal coverage. We examined indications for CS in public hospitals of one district in Bangladesh and explored factors influencing decision to perform the procedure.
Methods
Retrospective review of case notes of 530 women who had CS in 5 public hospitals in Thakurgaon District of Bangladesh. Key Informant Interviews (KII) with 18 service providers to explore factors associated with the decision to perform a CS.
Results
The commonest recorded indications for CS were: previous CS (29.4%), fetal distress (15.7%), cephalo-pelvic disproportion (10.2%), prolonged obstructed labor (8.3%) and post-term dates (7.0%). The majority (68%) of CS were performed as emergency; mainly during daytime working hours. Previous CS and “post-term dates” were common indications for elective CS with “post dates” – the commonest indication for CS in primiparous women. 16.0% of all CS were conducted for cases where alternative forms of care might have been more appropriate. Providers reported not using protocols and evidence based guidelines even though these are available. Pressure from patients and relatives to deliver by CS strongly influenced decision making. External agents from private hospitals receive a financial reward for every CS performed and are present in public hospitals to “lobby” for CS.
Conclusion
Factors other than evidence based practice or the presence of a clear medical indication influence providers’ decision to perform both elective and emergency CS in public hospitals in Bangladesh.

Item Type: Article
Subjects: WA Public Health > Health Problems of Special Population Groups > WA 310 Maternal welfare
WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WQ Obstetrics > Pregnancy Complications > WQ 240 Pregnancy complications (General)
WQ Obstetrics > Obstetric Surgical Procedures > WQ 415 Delivery (including preparatory manipulation)
WQ Obstetrics > Obstetric Surgical Procedures > WQ 430 Cesarean section. Symphysiotomy and similar techniques
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI): https://doi.org/10.1186/1471-2393-14-130
Depositing User: Caroline Hercod
Date Deposited: 11 Apr 2014 10:20
Last Modified: 21 Jun 2018 14:47
URI: http://archive.lstmed.ac.uk/id/eprint/3656

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