Implementing evidence-based guidelines on cesarean sections in Lebanon: Barriers and facilitators

Background: Lebanon has followed the worldwide trend in rising cesarean section rates with recent estimates of around 40%.  A number of clinical interventions are known to reduce the level of unnecessary cesarean sections and recently the effectiveness of policy-oriented interventions was also considered. This study aimed at adapting a set of indicators for cesarean section based on international guidelines to the context of Lebanon and at exploring care providers’ perceived barriers and facilitators on the implementation of these adapted guidelines.

Methods: The researchers convened with a group of obstetricians and midwives for the adaptation of c-section practice guidelines. Semi-structured interviews were conducted with a purposive sample of 12 obstetricians to identify perceived barriers and facilitators for the implementation of the adapted guidelines

Results: The main challenges identified by the obstetricians were related to the nature of the dominant private health care system in Lebanon, namely the convenience of c-sections for providers working individually, the lack of case audits in small facilities, the nurturing of a culture of acceptance for c-sections among women and deficient information and training in obstetrics. Some recommended strategies were strengthening the role of regulatory bodies within the private health care sector and developing systems for information exchange among providers.

Conclusion: The insights gained from the interviews will feed into the development of support tools for practice that can present more focused recommendations on day to day care and on key issues that have direct relevance to health care providers for the implementation of c-section practice guidelines.