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The decision to perform Caesarean section in Russia
Kirill Danishevski1, Martin McKee, Franco Sassi
1Open Health Institute, Moscow, Russian Federation.
Summary
Russian obstetricians show significant variation in recommending Caesarean sections, with factors like time of day and physician gender influencing decisions, not always aligning with evidence-based practice.
Area of Science:
- Obstetrics and Gynecology
- Health Services Research
- Clinical Decision-Making
Background:
- Russian clinical practice relies on centralized guidelines, often lacking evidence, leading to practice variations.
- Caesarean section recommendations, despite a strong evidence base, exhibit considerable facility-level variation in Russia.
Purpose of the Study:
- To identify factors influencing Russian obstetricians' decisions to recommend Caesarean sections.
- To understand the variability in Caesarean section recommendation practices.
Main Methods:
- Conjoint analysis was employed with 92 obstetricians from three regions.
- Obstetricians evaluated 30 vignettes combining 10 medical, social, and organizational factors.
Main Results:
- Significant variation exists in obstetricians' likelihood to recommend intervention.
- Factors like myopia or previous abortions influenced recommendations, diverging from international evidence.
- Intervention probability varied by time of day and obstetrician's gender.
Conclusions:
- Understanding clinical decision-making processes is crucial before implementing practice changes in Russia.
- Addressing unexplained variations in Caesarean section rates requires further investigation into influencing factors.
