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Among the greatest challenges in obstetrics today are the high cesarean section rates. For a number of years, the AKF Working Group on Women’s Health in Medicine, Psychotherapy, and Society has raised awareness on this issue (www.kaiserschnittkampagne.de). Its commitment to promoting women’s health on a political level across disciplines has significantly contributed to getting an S3 guideline on indications for cesarean section underway. Apart from high-quality guidelines capable of improving the quality of the practical work in the delivery rooms, it is essential to address the structural, organizational and economic conditions which have contributed to the decline in normal births.

The following innovations would contribute to the development of modern, safe, women- and family-centered obstetrics:

  • Early and routine integration of midwives in prenatal care could lessen the focus on risk and technology which dominates today’s obstetric care;
  • Nationwide implementation of one-on-one care in delivery rooms is a prerequisite for a relationship-centered and progressive culture of giving birth;
  • Making the topic of physiology of birth an integral part of the medical training curriculum would promote a deeper understanding of the normal process of giving birth;
  • Establishing regular, joint reflection rounds of the delivery room staff as well as planned basic and advanced training events addressing special obstetric situations would enhance the ability of doctors and midwifes to handle special and emergency situations; and
  • the removal of the wrong financial incentives existing under the DRG system, which discourage natural birth, would alleviate economic pressure.

Maternal request for cesarean section in the absence of medical indications, mainly driven by fear of giving birth (1), represents a particular challenge. It is known that many pregnant women change their mind after in-depth advice and retrospectively rate their decision to have a normal birth as good (2). This highlights the high importance of comprehensive advice and a trustful relationship. Obstetric care in Germany could be advanced a step further by developing, applying and evaluating structured and quality-assured consulting concepts.

DOI: 10.3238/arztebl.2016.0191b

Sabine Striebich

Arbeitskreis Frauengesundheit in Medizin, Psychotherapie

und Gesellschaft e.V. (AKF)

sabine.striebich@freenet.de

Conflict of interest statement

The author declares that no conflict of interest exists.

1.
Nieminen K, Stephansson O, Ryding EL: Women’s fear of childbirth and preference for cesarean section—a cross-sectional study at various stages of pregnancy in Sweden. Acta Obstet Gynecol Scand 2009; 88: 807–13 CrossRef MEDLINE
2.
Nerum H, Halvorsen L, Sorlie T, Osian P: Maternal request for a cesarean section due to fear of birth—can it be changed through crisis orientated counseling? Birth 2006; 33: 221–8 CrossRef MEDLINE
3.
Mylonas I, Friese K: The indications for and risks of elective cesarean section. Dtsch Arztebl Int 2015; 112: 489–95 VOLLTEXT
1.Nieminen K, Stephansson O, Ryding EL: Women’s fear of childbirth and preference for cesarean section—a cross-sectional study at various stages of pregnancy in Sweden. Acta Obstet Gynecol Scand 2009; 88: 807–13 CrossRef MEDLINE
2.Nerum H, Halvorsen L, Sorlie T, Osian P: Maternal request for a cesarean section due to fear of birth—can it be changed through crisis orientated counseling? Birth 2006; 33: 221–8 CrossRef MEDLINE
3.Mylonas I, Friese K: The indications for and risks of elective cesarean section. Dtsch Arztebl Int 2015; 112: 489–95 VOLLTEXT

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