Melissa Kemp and Dr. Sheri Palmer, College of Nursing
Over 850,000 unnecessary C-sections are performed each year in Latin America (Belizán, Althabe, Barros, & Alexander, 1999). According to a recent annual report of the Sotomayor Maternity Hospital in Guayaquil, Ecuador, 58% of total births were cesarean (Junta de B., 2004). In comparison, the overall cesarean rate in the U.S. (which is also high according to medical recommendations) is reported to be about 27% (NCHS, 2003). Unnecessary cesarean sections have resulted in increased infection, hemorrhage, damage to abdominal and urinary tract organs, drug complications, prematurity, increased neonatal illness, and longer hospitalization (Sloan et al, 2000). These reported rates in Ecuador represent an unnecessary increased risk for mothers and their babies and an increased economic burden. A research study was conducted to investigate contributing factors for the high C-section rates in this region.
In May 2005, during a study abroad nursing school experience, data concerning cesarean sections was collected at the Sotomayor Maternity Hospital. A convenience sample of 32 post-partum C-section women and eight physicians were interviewed using a demographic questionnaire as well as research questions related to C-sections. Physicians were asked what factors influence their decision for cesarean sections. Hospital statistics were also collected.
All eight doctors viewed cesarean primarily as a medical means of preventing childbirth complications. They expressed their concern regarding the elevated cesarean rate while acknowledging the high-risk status of their patient population. This is something I can attest to from my observations there. Many of the moms who came in had not been in for many (if any) prenatal visits because they didn’t have the money or they lived too far from a clinic. Quite a few were very young, unmarried moms with little education and very limited financial resources. All of these factors put the mothers at higher risk, which may lead delivery doctors to resort to cesarean. The sample of post-partum C-section women had a median age of 23 and mean of 25.75. The most common marital status of the sample was cohabitation (unión libre). Also, 59% of the women interviewed had not finished high school, 72% had at least one close relative, and 25% had three or more close relatives who had previously had a C-section.
I found that major differences exist in the cesarean rate between the general population (primarily those of lower economic status) and privately-insured patients. For 2004, the cesarean rate for the general population was 54.3% and for privately-insured patients was 85.3% (Junta de B., 2004). Although the general population is a higher-risk group, there are other factors that are driving the lower-risk population (privately-insured patients) to undergo childbirth via C-section at a higher rate. Such factors may include the desire for a painless childbirth, convenience on the part of doctors and mothers, avoidance of unpredictable timing, preservation of reproductive and urinary tract organs, financial gains for doctors, and others. Research that focuses on the privately-insured patients needs further development.
This work has not been without its challenges. One major barrier to my research was the difficulty in interviewing patients from the private sector. Given what I found with the hospital statistics that 85.3% of the privately-insured patients undergo cesarean, I was very interested in the explanations for the private group. However, because of the relatively few privately-insured (higher socioeconomic status) patients in this particular hospital and the restricted access to their rooms, I was only able to interview three private-paying mothers out of the thirty-two total.
Another obstacle was the standardization of statistical information that was gathered. In retrospect, it would have been more valuable to have categorized the mother’s responses to demographic and interview questions, instead of allowing free-response.
Overall, this has been an invaluable educational experience for me. Some of the findings surprised me, such as the colossal percentage (85.3%) of private-paying women who undergo a cesarean at this facility and the plausibility of the higher-risk status of the general population being a valid cause for an elevated cesarean rate. I presented and published my findings in April 2006 at the NCUR (National Conference of Undergraduate Research) in Asheville, North Carolina. I also presented at the Brigham Young University College of Nursing Research Conference in March 2006. After graduating from nursing school in April 2006, I began working as a registered nurse in the intensive care unit. This research has and will undoubtedly continue to aid me in my nursing career. I hope to use this experience and the principles learned to make a difference in furthering important research and improving healthcare.
References
- Belizán, J.M., Althabe, F., Barros, F.C., Alexander, S. Rates and implications of caesarean sections in Latin America: ecological study. British Medical Journal 1999; 319: 1397-1400.
- Junta de Beneficencia de Guayaquil. The Solidarity of the Junta de Beneficiencia de Guayaquil. Guayaquil, Ecuador. 2004.
- National Center for Health Statistics, www.cdc.gov/nchs/faststats/delivery.htm
- Sloan, N.L., Pinto, E., Calle, A., Langer, A., Winikoff, B., Fassihian, G. Reduction of the cesarean delivery rate in Ecuador. International Journal of Gynecology & Obstetrics 2000; 69: 229-36.