Attitudes towards mode of delivery and cesarean on demand in Turkey

Afyon Kocatepe University, Faculty of Medicine, Department of Obstetrics and Gynecology, Afyonkarahisar, Turkey.
International Journal of Gynecology & Obstetrics (Impact Factor: 1.54). 12/2007; 99(3):233-5. DOI: 10.1016/j.ijgo.2007.05.031
Source: PubMed


To assess the attitudes of healthcare providers and the public in Turkey towards mode of delivery and cesarean delivery on demand.
A written questionnaire was given to female healthcare providers and women from the general public, and their answers were analyzed.
A total of 329 female healthcare providers and 347 women from the public group completed the survey. In response, 48.1% of healthcare providers and 69.6% of the public group chose vaginal delivery as the preferred mode of delivery (P<0.001). Some 45.3% of healthcare providers and 20.6% of the public group had undergone a cesarean delivery without any medical indications (P<0.001). In addition, 37.8% of healthcare providers and 36.2% of the public group believed that women should have the right to a cesarean delivery on demand.
In the two groups studied the preference for cesarean delivery is higher in Turkish healthcare providers than in the public population. In both groups the attitude towards cesarean delivery on demand is high.

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    • "In 1997, in one of the pioneering studies conducted on this subject, Al-Mufti, McCarthy and Fish [19] reported that 17% of obstetricians participating in a study in London preferred a Cesarean section even when no complications were present. Interviews conducted in a hospital in Turkey in 2007 [20] found that more than half the healthcare professionals (physicians, nurses, midwives and laboratory technicians) believed that Cesarean sections were safer for the baby. In Norway, a study conducted in 2008 found that more than a quarter of obstetricians/gynecologists had already been submitted to a Cesarean section compared to a rate of only 12% in the general population [21]. "
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    ABSTRACT: Background The increase in overall rates of cesarean sections (CS) in Brazil causes concern and it appears that multiple factors are involved in this fact. In 2009, undergraduate students in the first and final years of medical school at the University of Santa Catarina answered questionnaires regarding their choice of mode of delivery. The aim of the study was to evaluate whether the education process affects decision-making regarding the waay of childbirth preferred by medical students. Methods A cross-sectional, quantitative study was conducted based on data obtained from questionnaires applied to medical students. The questions addressed four different scenarios in childbirth, as follows: under an uneventful pregnancy; the mode of delivery for a pregnant woman under their care; the best choice as a healthcare manager and lastly, choosing the birth of their own child. For each circumstance, there was an open question to explain their choice. Results A total of 189 students answered the questionnaires. For any uneventful pregnancy and for a pregnant woman under their care, 8.46% of the students would opt for CS. As a healthcare manager, only 2.64% of the students would recommend CS. For these three scenarios, the answers of the students in the first year did not differ from those given by students in the sixth year. In the case of the student’s own or a partner’s pregnancy, 41.4% of those in the sixth year and 16.8% of those in the first year would choose a CS. A positive association was found between being a sixth year student and a personal preference for CS according to logistic regression (OR = 2.91; 95%CI: 1.03–8.30). Pain associated with vaginal delivery was usually the reason for choosing a CS. Conclusions A higher number of sixth year students preferred a CS for their own pregnancy (or their partner’s) compared to first year students. Pain associated with vaginal delivery was the most common reason given for haven chosen a CS. The students’ preference for childbirth changed over time during their graduation in favor of cesarean sections. This finding deserves considerable attention when structuring medical education in Obstetrics.
    BMC Medical Education 07/2012; 12(1):57. DOI:10.1186/1472-6920-12-57 · 1.22 Impact Factor
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    ABSTRACT: Introduction.  Exploring the hypothesis that “sexual function” is associated with mode of delivery is important, because sexual health is an integral part of general health.Aim.  The aim of this study was to quantify the relationship between mode of delivery and subsequent incidence of sexual dysfunction and impairment of quality of life (QOL) both in women and their husbands.Main Outcome Measures.  Sexual function of pregnant women and their husbands was assessed using Female Sexual Function Index (FSFI), and International Index of Erectile Function (IIEF), respectively. All women and their husbands were also asked to indicate their sexual satisfaction on a scale of 0–5 as proposed by Kim and Paick. QOL was also assessed by Short Form-36 Health Survey.Methods.  A total of 912 pregnant women (mean age 26 ± 2, range 21–32 years, parity I) and their husbands were recruited in this prospective study. The subjects were subdivided into five groups according to their mode of delivery, including: group A, spontaneous vaginal delivery (SVD) without injuries (group SVD, N = 184); group B, vaginal delivery with episiotomy (VDE) or perineal laceration (group VDE, N = 182); group C, operative vaginal delivery (OVD) (instrumental delivery) (group OVD, N = 180), group D, planned cesarean section (PCS) (group PCS, N = 182); and group E, emergency cesarean section (ECS) (group ECS, N = 184).Results.  Of women in groups A, B, C, D, and E, 72 (42.6%), 62 (37.1%), 54 (32.7%), 108 (64.3%), and 64 (38.3%) resumed sexual intercourse (SI) within 8 weeks after delivery. Women with vaginal delivery and emergency cesarean section had statistically significant lower FSFI scores as compared with PCS women. Women who experienced a PCS had lowest pain scores, and women who had OVD had highest pain scores at first SI (P = 0.001). The IIEF domains scores for erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction with sex life did differ significantly between particular groups. The research has shown that the QOL parameters for PCS women were generally higher than for the other groups, and this concerns almost all categories.Conclusions.  In healthy women with normal singleton pregnancies at term, instrumental deliveries are associated with the highest and PCS associated with the lowest rate of long-term maternal and paternal sexual dysfunction. Safarinejad MR, Kolahi AA, and Hosseini L. The effect of the mode of delivery on the quality of life, sexual function, and sexual satisfaction in primiparous women and their husbands. J Sex Med 2009;6:1645–1667.
    Journal of Sexual Medicine 03/2009; 6(6):1645 - 1667. DOI:10.1111/j.1743-6109.2009.01232.x · 3.15 Impact Factor
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    ABSTRACT: To explore the impact of gender roles in relation to health seeking behaviour during pregnancy and childbirth. The study was conducted in neighbourhoods with low antenatal care rates in three provinces of Turkey. The study population consisted of pregnant women who never got or discontinued antenatal care and their peers, families and community leaders. Sixteen focus group discussions and 125 in-depth interviews were conducted with a total of 239 participants. Pregnancy and childbirth are interwoven strongly with gender roles. Since the patriarchal system acknowledges women through the means of childbirth, women are expected to have many children. Hence women experience pregnancy as a burden and are not motivated to seek antenatal care. During pregnancy, only 'serious' conditions are considered as legitimate reasons for accessing care. However, the decision regarding whether a pregnant woman is seriously sick or not belongs to the responsibilities of elder women, which delays service use. Providing information regarding the value of antenatal care also to elder women is essential in increasing the demand to the services. Incorporating gender perspectives into daily health practice and maintaining access to high quality reproductive care services are vital in reducing the gender based barriers to care.
    The European Journal of Contraception and Reproductive Health Care 05/2009; 14(4):290-300. DOI:10.1080/13625180902925211 · 1.39 Impact Factor
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