title: A Pilot Study of the Perceptions of Actively Practicing Obstetricians in Puerto Rico: Factors that Influence Decision Making in Cesarean Delivery.
abstract: The reported cesarean delivery (CD) rate for 2012 in Puerto Rico was higher than that of the United States (48.5% and 32.8%, respectively). Multiple reasons for and consequences of the high rates of CD exist. The decision to perform a CD is based on multiple factors, some of which are not obstetrical. In order to better understand those factors, the pilot study described in this manuscript analyzed data collected from obstetricians themselves.
  
  
  
  During 2011, convenience sampling was used to collect data from active obstetric practitioners attending the Caribe Gyn 2011 conference in Ponce, Puerto Rico. A self-administered survey was piloted and analyzed using formative content analysis. Obstetricians were asked to name factors that contribute to their decision to perform a CD and factors they felt influence other obstetricians to make that decision.
  
  
  
  In general, common maternal and fetal causes for choosing CD were noted. Hypertensive disorders (60%) and abnormal intrapartum fetal tracing (83%) were highly rated, as were non-obstetrical factors, including physician convenience (52%) and concern for medical liability for vaginal delivery (50%).
  
  
  
  According to the participating obstetricians, many factors associated with the standard practice of obstetrics influence the decision to perform a CD. However, non-obstetrical reasons were also found. Future studies using a larger sample of Puerto Rican obstetricians are required to fully understand these factors in order to both address them through educational interventions for patients, physicians, administrators, and insurers, and inform public policy.
authors.affiliation: Department of Obstetrics and Gynecology, School of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, PR.
authors.forename: Alberto M
authors.initials: AM
authors.lastname: Carrera
authors.affiliation: Post-doctoral Master of Science in Clinical and Translational Research Program (MSc), School of Health Professions, University of Puerto Rico Medical Sciences Campus, San Juan, PR; Press Ganey Associates, Inc., South Bend, Indiana.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Sternke
authors.affiliation: Department of Obstetrics and Gynecology, School of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, PR.
authors.forename: Juana I
authors.initials: JI
authors.lastname: Rivera-Viñas
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D002585:Cesarean Section / Q000706:statistics & numerical data*; D003657:Decision Making; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009774:Obstetrics / Q000706:statistics & numerical data*; D010820:Physicians / Q000706:statistics & numerical data*; D010865:Pilot Projects; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D011647:Puerto Rico
keywords: Cesarean Delivery; Decision Making; Epidemiology; Obstetrics; Public Health Policy; Puerto Rico