|Dimensions||Barriers and enablers||Dimensions||Barriers and enablers|
|Factors related to the motivation and attitudes of healthcare professionals|
|Legal and medical pressure and professional prestige||Barriers|
- Professionals end up doing Defensive Medicine or conservative clinical practice; the specific nature of obstetrics and gynecology mean the pressure is higher in this specialty.
- Doing a cesarean is considered a safe-conduct in the event of a legal dispute
- The responsibility falls more on medical professionals than on midwives
- Pressure due to professional prestige, and individual responsibility
|Econ-omic incen-tives, compensation||Barriers|
- Absence of non-economic incentive system
- Questions regarding validity of individual evaluations of personnel. Suspicion that the audits do not take into account the causative factors
- The economic incentives are low and do not appear to be enablers
- Satisfaction gleaned from doing a good job, recognition by the patients of the care provided
- The audits, if they are positive, serve as positive reinforcement of an individual’s clinical practice and if they are negative they facilitate improvement.
|Personal situation and clinical skill||Barriers:|
- Demotivation caused by changes related to the economic crisis and deterioration of working conditions.
- Practices sometimes based on convenience for the professional
|- Some obstetric practices are no longer used, such as external version, and know-how is being lost because they are no longer taught. Some instrumental practices are not as well known as before, while providers continue to use and have a good command of cesarean deliveries.|
|Factors related to the women giving birth and their families|
|Pressure on professionals||Barriers|
- Fear of pain
- Bad experiences in past or of close friends/family.
- Impatience in waiting for delivery to progress naturally
- Pre-conceived ideas about the “ideal delivery”.
- Improved information circuits for patients and their families
|Trust in the professionals||Barriers|
- Reduced prestige of hospital
- Distrust and fear of National Healthcare System and its professionals.
- The main fear for conquering fears and prejudices is communication.
- Communication and information exchange during entire gestation is fundamental: women in labor are less likely to assimilate new information.
- Misinformation based on confusion and myths
- Excess of information may overwhelm women
- Contradictions in information from the private system (used for care during pregnancy) and the public system
- Patients who have little decision-making capacity
- Women who want to have “too much” control
- Patients who are well-informed by midwife and gynecologist and do not have too many external influences
- Patients who know that birth is physiological and natural and the less intervention the better