Caesarean birth in public maternities in Argentina: a formative research study on the views of obstetricians, midwives, and trainees.

ObjectivesTo explore obstetricians, midwives, and trainees perceptions of CS determinants in the context of public obstetric care services provision in Argentina. Our hypothesis is that known determinants of CS use may differ in settings with limited access to essential obstetric services. SettingWe conducted a formative research study in nineteen public maternity hospitals in Argentina. An institutional survey assessed the availability of essential obstetric services. Subsequently, we conducted online surveys and semi-structured interviews to assess the opinions of providers on known CS determinants. ResultsObstetric services showed an adequate provision of emergency obstetric care but limited services to support women during birth. Midwives, with some exceptions, are not involved during labour. We received 680 surveys from obstetricians, residents, and midwives (response rate of 63%) and interviewed 26 key informants. Six out of ten providers (411, 61%) indicated that the use of CS is associated with the complexities of our caseload. Limited pain management access was deemed a potential contributing factor for CS in adolescents and first-time mothers. Providers have conflicting views on the adequacy of training to deal with complex or prolonged labour Obstetricians with more than ten years of clinical experience indicated that fear of litigation was also associated with CS. Overall, there is consensus on the need to implement interventions to reduce unnecessary CS. ConclusionsPublic Maternity Hospitals in Argentina have made significant improvements in the provision of emergency services. The environment of service provision does not seem to facilitate the physiological process of vaginal birth. Providers acknowledged some of those challenges. Article SummaryO_ST_ABSStrengths and limitations of this studyC_ST_ABSO_LIThis study is one of the few studies exploring the perceptions of providers working in low-resourced settings in middle-income countries on the determinants of increasing trends of CS. C_LIO_LILarge sample and representation of all professionals and obstetric tasks working in low-resourced settings. C_LIO_LICluster analysis allowed to describe the response variability across professional groups in relation to specific CS determinants. C_LIO_LIThe use of Formative Research is a valuable tool to inform the design and implementation of future interventions. C_LIO_LIEven though the response rate is good (63%) those who did not respond may have different views on the determinants of CS. C_LIO_LISome participant hospitals had lower response rate. C_LI