Skip to main content

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