Table 5 Summary of program barriers and enablers related to the healthcare professionals and to the women and their families
From: Barriers and enablers in the implementation of a program to reduce cesarean deliveries
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 Enablers - 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 Enablers - 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”. Enablers - 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. Enablers - 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. |
Information | Barriers - 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 | Role | Barriers - Patients who have little decision-making capacity - Women who want to have “too much” control Enablers - 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 |