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Table 1 Barriers of reducing C-Section rate in Iran; Categories, Themes and subthemes

From: Cesarean section rate in Iran, multidimensional approaches for behavioral change of providers: a qualitative study

Categories Theme/subthemes  
Economic and Political Context  
   • Economic Issues Lower tariff for vaginal delivery compared to C-section
  The low share of midwife from vaginal delivery tariff
  Fee for service payment methods
  The role and responsibilities of insurance companies
   • Legal issues Multiple centers for dealing with medical errors
  No respect for the physicians in the court
  Incapability to judge based on the existing condition and available facilities
  Lack of criteria for selecting technicians in the legal system, low knowledge and skill among the technicians,
  The absence of practical guidelines for judges
  Ignoring the stem of the problem
  Inability to produce evidence-based and scientific proofs due to technological problems
  Simplicity of filing a complaint by families
  The absence of any support for midwives
  The high price of blood money
Individual Professional Physicians' good perception about cesarean section complications
  Physician's declining skills of managing vaginal delivery
  The Teaching residents system
  Midwives' declining skills of managing vaginal delivery
  The teaching midwives system
  Lack of ethics in suggesting cesarean section without indication by providers
Organizational context Hospital Management Methods (Autonomous Hospitals)
  Hospital type (public, private, teaching or referral)
  Lack of on call physicians
  Lack of physicians and midwives' job descriptions
  Lack of human resources specialized in obstetrics
  Lack of human resources specialized in midwifery
  Additional Interventions
  Unsuitable attitude toward mothers in the labor Room lack of acceptable facilities of the labor Room
  Lack of suitable pregnancy care provision
Social context Lack of cooperation at associative levels between midwives and specialists
  Distrust between midwives and specialists in hospitals
Innovation (vaginal delivery) Time consuming
  High stress levels
  Being unpredictable