Caesarean section on request:: a comparison of obstetricians' attitudes in eight European countries
Caesarean section on request:: a comparison of obstetricians' attitudes in eight European countries
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DOI：
10.1111/j.1471-0528.2006.00933.x
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发表时间：
2006-06-01
影响因子：
5.8
通讯作者：
Cuttini, M.
中科院分区：
文献类型：
--
作者：
Habiba, M.;Kaminski, M.;Cuttini, M.
目的探讨产科医生在无医学指征的情况下对产妇要求进行剖腹产的态度。设计整群抽样横断面调查。在8个欧洲国家设置新生儿重症监护室（NICU）相关产科单位。人口产科医生至少有6个月的临床经验。方法通过人口普查选择卢森堡的NICU相关产科单位，荷兰和瑞典，在法国、德国、意大利、西班牙和英国进行地理分层随机抽样。结果105个单位和1530名产科医生参加了本研究（应答率分别为70%和77%），其中1530名产科医生接受了剖腹产手术，1530名产科医生接受了剖腹产手术。在西班牙（15%）、法国（19%）和荷兰（22%），仅仅因为“她的选择”而同意一名假设的妇女要求进行选择性剖腹产的比例最低;德国（75%）和英国（79%）最高，其余国家居中。使用加权多变量logistic回归，执业国家（P < 0.001），害怕诉讼（P = 0.004）和在大学附属医院工作（P = 0.001）与医生同意患者要求的可能性相关。有子女的女医生的子集不太可能同意（OR 0.29，95%CI 0.20-0.42）。结论产科医生的态度的差异不是建立在具体的医学证据。文化因素、法律的责任和与各国具体围产期保健组织有关的变量都发挥了作用。应更加重视了解妇女要求选择剖腹产的动机、价值观和恐惧。
Objective To explore the attitudes of obstetricians to performe a caesarean section on maternal request in the absence of medical indication.Design Cluster sampling cross-sectional survey.Setting Neonatal Intensive Care Unit (NICU) associated maternity units in eight European countries.Population Obstetricians with at least 6 months clinical experience.Methods NICU-associated maternity units were chosen by census in Luxembourg, Netherlands and Sweden and by geographically stratified random sampling in France, Germany, Italy, Spain and UK. An anonymous, self-administered questionnaire was used for data collection.Main outcome measures Obstetricians' willingness to perform a caesarean section on maternal request.Results One hundred and five units and 1530 obstetricians participated in the study (response rates of 70 and 77%,respectively). Compliance with a hypothetical woman's request for elective caesarean section simply because it was 'her choice' was lowest in Spain (15%), France (19%) and Netherlands (22%); highest in Germany (75%) and UK (79%) and intermediate in the remaining countries. Using weighted multivariate logistic regression, country of practice (P < 0.001), fear of litigation (P = 0.004) and working in a university-affiliated hospital (P = 0.001) were associated with physicians' likelihood to agree to patient's request. The subset of female doctors with children was less likely to agree (OR 0.29, 95% CI 0.20-0.42).Conclusions The differences in obstetricians' attitudes are not founded on concrete medical evidence. Cultural factors, legal liability and variables linked to the specific perinatal care organisation of the various countries play a role. Greater emphasis should be placed on understanding the motivation, values and fears underlying a woman's request for elective caesarean delivery.