Mode of Childbirth in Low-Risk Pregnancies: Nicaraguan Physicians’ Viewpoints
To explore attitudes of physicians attending births in the public and private sectors and at the managerial level toward cesarean birth in Nicaragua. A qualitative study was conducted consisting of four focus groups with 17 physicians and nine in-depth interviews with decision-makers. Although study participants listed many advantages of vaginal birth and disadvantages of cesarean birth, they perceived that the increase in the cesarean birth rate in Nicaragua has resulted in a reduction in perinatal morbidity and mortality. They ascribed high cesarean birth rates to a web of interrelated provider, patient, and health system factors. They identified five actions that would facilitate a reduction in the number of unnecessary cesarean operations: establishing standards and protocols; preparing women and their families for labor and childbirth; incorporating cesarean birth rate monitoring and audit systems into quality assurance activities at the facility level; strengthening the movement to humanize birth; and promoting community-based interventions to educate women and families about the benefits of vaginal birth. Study participants believe that by performing cesarean operations they are providing the best quality of care feasible within their context. They do not perceive problems with their current practice. The identified causes of unnecessary cesarean operations in Nicaragua are multifactorial, so it appears that a multi-layered strategy is needed to safely reduce cesarean birth rates. The recent Nicaraguan Ministry of Health guidance to promote parto humanizado (“humanization of childbirth”) could serve as the basis for a collaborative effort among health care professionals, government, and consumer advocates to reduce the number of unnecessary cesarean births in Nicaragua.
KeywordsQualitative research Health personnel Mode of delivery Cesarean section
Nicaraguan Social Security Institute
Ministry of Health/Ministerio de Salud
Program for Appropriate Technology in Health
United States Agency for International Development
This study was made possible by the generous support of the American people through the United States Agency for International Development (USAID), under the terms of the Leader with Associates Cooperative Agreement GHS-A-00-08-00002-00. The contents are the responsibility of the Maternal and Child Health Integrated Program (MCHIP) and do not necessarily reflect the views of USAID or the United States government. The intervention was implemented by the Ministry of Health of Nicaragua (MINSA) with technical support from USAID’s flagship maternal, neonatal and child health program (MCHIP), PATH/Seattle and Managua, the Institute for Clinical Effectiveness and Health Policy (IECS), and the Montevideo Clinical and Epidemiological Research Unit (UNICEM). We thank Yann Lacayo, Henry Espinoza and Margarita Quintanilla from PATH/Nicaragua for their help in the organization of the focus groups and in-depth interviews.
Conflict of interest
The authors declare that they have no competing interests.
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