Barriers and enablers in the implementation of a program to reduce cesarean deliveries
Bibliographic record
Abstract
Conducting audits, implementing best practices and giving feedback to the professionals have shown considerable promise in reducing rates of cesarean delivery and mother-child morbidity. The purpose of the study is two-fold: a) to identify the factors that facilitate change in current practices and thus reduce the use of obstetric interventions, and b) to better understand the barriers to such changes. To reach these objectives, the study analyzed the experiences of professionals participating in a program to reduce cesarean rates in 20 hospitals in Andalusia (Spain). A qualitative exploratory study was conducted. Participants were 14 ob-gyns and 14 nurse-midwives who work for Spain’s National Healthcare System and have been involved in the program. To gather information, in-depth individual interviews were used. The interview was designed to examine factors affecting the quality of care, such as issues related to policy/management, hospitals, practitioners and patients. The barriers identified include: 1) At the policy/management level: limited influence of institutional policy and the scant political commitment perceived. 2) At the organizational level: separation of the hierarchical structure of doctors from that of nurse-midwives, few positive incentives and the strong threat of sanctions for malpractice, inappropriate reorganization of midwife/obgyns competences. 3) At the healthcare staff and facility level: reluctance to change accentuated by years of professional practice. 4) Physical resources: obsolete delivery rooms with a medical look. 5) At the professional level: medical and legal pressure, cesarean delivery considered safe in the event of a legal claim, low motivation due to decline in working conditions, convenience-based practices. 6) Woman giving birth and her family: fear of pain, impatience while waiting for process to occur, misinformation. The enablers include: 1) At the organizational level: good coordination with pediatrics and emergency departments, 2) Training: skills updates for a less-interventionist approach, increased awareness, 3) Health professionals: satisfaction for a job well done, recognition by patients. 4) Woman giving birth: information circuits for patients and their families, trust in health professionals. The results can contribute to the design of more effective knowledge translation interventions to reduce cesarean sections, based on overcoming obstacles, reinforcing enabling factors and attempting to (re)define the boundaries between research and practice.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.016 | 0.038 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.003 | 0.001 |
| Open science | 0.001 | 0.003 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".