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- Habiba, M, et al.
(författare)
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Caesarean section on request: a comparison of obstetricians' attitudes in eight European countries
- 2006
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Ingår i: BJOG: An International Journal of Obstetrics & Gynaecology. - : Wiley. - 1471-0528 .- 1470-0328. ; 113:6, s. 647-656
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Tidskriftsartikel (refereegranskat)abstract
- 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.
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| 2. |
- Habiba, M., et al.
(författare)
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Late termination of pregnancy: a comparison of obstetricians' experience in eight European countries
- 2009
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Ingår i: BJOG: An International Journal of Obstetrics & Gynaecology. - : Wiley. - 1471-0528 .- 1470-0328. ; 116:10, s. 1340-1349
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Tidskriftsartikel (refereegranskat)abstract
- Objective To compare the experience and attitude of obstetricians in Europe towards late termination of pregnancy and the factors affecting their responses. Design Cluster sampling cross-sectional survey. All neonatal intensive care unit (NICU)-associated maternity units were recruited (census sampling) in Luxembourg, the Netherlands and Sweden. In France, Germany, Italy, Spain and the UK, units were selected at random. In every recruited unit, all obstetricians with at least 6 months' experience were invited to participate. Setting NICU-associated maternity units in eight European countries. Population Obstetricians with at least 6 months' clinical experience. Methods An anonymous, self-administered questionnaire was used. Multinomial logistic analysis was used to identify factors predicting the obstetricians' views about modifying the law governing late termination in their country. Main outcome measure Obstetricians' experience of late termination of pregnancy and views about national policies. Results One hundred and five units and 1530 obstetricians participated (response rates 70 and 77% respectively). The most common indications for late termination were congenital anomalies and women's physical health. Feticide was not common except in France, Luxembourg and the UK. Active euthanasia of a liveborn was practiced in France and the Netherlands. Obstetricians in Germany were more likely to feel that late termination should be more severely restricted, the opposite was true in Spain and the Netherlands. In Italy, there was dissatisfaction with current status, but opinion was divided, reflecting views on both sides of the debate. Conclusions This research outlines current practice in a difficult and sensitive area and suggests the need for more discussion and support for all those who were involved.
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