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Background <p>Cesarean section rates are rising globally, and Thailand has experienced steady growth in non-medically indicated cesarean sections (NMICS). Because clinician and administrator perspectives influence practice, mapping their attitudes and perceptions is essential to design interventions that reduce unnecessary cesareans.</p> Methods <p>We conducted a prospective descriptive implementation study approved by the Siriraj Ethics Committee (Si-802/2023) and registered with the Thai Clinical Trials Registry (TCTR20230913007). Methods comprised in-depth interviews, questionnaire development, and a nationwide survey. Between March and July 2025, a validated questionnaire was administered to 120 physicians at tertiary hospitals in Thailand, with sample size based on a 95% confidence level and 5% allowable error. Data were analyzed using descriptive statistics, chi-square tests, and multivariable logistic regression, and associations were reported as adjusted odds ratios (aORs) with 95% confidence intervals (CIs).</p> Results <p>Of 120 respondents, 60.8% reported performing NMICS and 63.0% acknowledged agreeing to patient requests. In multivariable analysis, fear of litigation (aOR 2.5, 95% CI 1.1–5.8) and workload pressures (aOR 2.0, 95% CI 0.9–4.2) were associated with NMICS practice. Agreement to patient requests was more likely in private hospitals (aOR 1.9) and among physicians citing litigation concerns (aOR 2.1). Support for hospital reduction policies was linked to the presence of an action plan (aOR 2.8) and to the belief that NMICS increases costs (aOR 2.2). Despite these concerns, many physicians minimized NMICS consequences, and fewer than one-third of hospitals had active reduction initiatives.</p> Conclusions <p>NMICS in Thailand reflects not only litigation risk and workload but also attitudes of unconcern, normalization of cesarean delivery, cultural beliefs, and systemic barriers. Reducing unnecessary cesareans will require strengthened informed consent through standardized consent forms and decision aids, culturally sensitive education, and adoption of non-clinical interventions, such as those put forward by the Quali-Dec (“Quality Decision-Making by Women and Providers”) project.</p> Trial registration <p>Registered at Thai Clinical Trials Registry (reference: TCTR20230913007).</p>

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Physician attitudes and system factors associated with non-medically indicated cesarean sections in Thailand: a prospective implementation study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月3日

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  • Vitaya Titapant,
  • Saifon Chawanpaiboon,
  • Attapol Kanjanapongporn,
  • Julaporn Pooliam,
  • Sanitra Anuwutnavin

摘要

Background

Cesarean section rates are rising globally, and Thailand has experienced steady growth in non-medically indicated cesarean sections (NMICS). Because clinician and administrator perspectives influence practice, mapping their attitudes and perceptions is essential to design interventions that reduce unnecessary cesareans.

Methods

We conducted a prospective descriptive implementation study approved by the Siriraj Ethics Committee (Si-802/2023) and registered with the Thai Clinical Trials Registry (TCTR20230913007). Methods comprised in-depth interviews, questionnaire development, and a nationwide survey. Between March and July 2025, a validated questionnaire was administered to 120 physicians at tertiary hospitals in Thailand, with sample size based on a 95% confidence level and 5% allowable error. Data were analyzed using descriptive statistics, chi-square tests, and multivariable logistic regression, and associations were reported as adjusted odds ratios (aORs) with 95% confidence intervals (CIs).

Results

Of 120 respondents, 60.8% reported performing NMICS and 63.0% acknowledged agreeing to patient requests. In multivariable analysis, fear of litigation (aOR 2.5, 95% CI 1.1–5.8) and workload pressures (aOR 2.0, 95% CI 0.9–4.2) were associated with NMICS practice. Agreement to patient requests was more likely in private hospitals (aOR 1.9) and among physicians citing litigation concerns (aOR 2.1). Support for hospital reduction policies was linked to the presence of an action plan (aOR 2.8) and to the belief that NMICS increases costs (aOR 2.2). Despite these concerns, many physicians minimized NMICS consequences, and fewer than one-third of hospitals had active reduction initiatives.

Conclusions

NMICS in Thailand reflects not only litigation risk and workload but also attitudes of unconcern, normalization of cesarean delivery, cultural beliefs, and systemic barriers. Reducing unnecessary cesareans will require strengthened informed consent through standardized consent forms and decision aids, culturally sensitive education, and adoption of non-clinical interventions, such as those put forward by the Quali-Dec (“Quality Decision-Making by Women and Providers”) project.

Trial registration

Registered at Thai Clinical Trials Registry (reference: TCTR20230913007).