Do women prefer caesarean sections? A qualitative evidence synthesis of their views and experiences.

BACKGROUND: Caesarean sections (CS) continue to increase worldwide. Multiple and complex factors are contributing to the increase, including non-clinical factors related to individual women, families and their interactions with health providers. This global qualitative evidence synthesis explores women's preferences for mode of birth and factors underlying preferences for CS. METHODS: Systematic database searches (MEDLINE, EMBASE, CINAHL, PsycINFO) were conducted in December 2016 and updated in May 2019 and February 2021. Studies conducted across all resource settings were eligible for inclusion, except those from China and Taiwan which have been reported in a companion publication. Phenomena of interest were opinions, views and perspectives of women regarding preferences for mode of birth, attributes of CS, societal and cultural beliefs about modes of birth, and right to choose mode of birth. Thematic synthesis of data was conducted. Confidence in findings was assessed using GRADE-CERQual. RESULTS: We included 52 studies, from 28 countries, encompassing the views and perspectives of pregnant women, non-pregnant women, women with previous CS, postpartum women, and women's partners. Most of the studies were conducted in high-income countries and published between 2011 and 2021. Factors underlying women preferences for CS had to do mainly with strong fear of pain and injuries to the mother and child during labour or birth (High confidence), uncertainty regarding vaginal birth (High confidence), and positive views or perceived advantages of CS (High confidence). Women who preferred CS expressed resoluteness about it, but there were also many women who had a clear preference for vaginal birth and those who even developed strategies to keep their birth plans in environments that were not supportive of vaginal births (High confidence). The findings also identified that social, cultural and personal factors as well as attributes related to health systems impact on the reasons underlying women preferences for various modes of birth (High confidence). CONCLUSIONS: A wide variety of factors underlie women's preferences for CS in the absence of medical indications. Major factors contributing to perceptions of CS as preferable include fear of pain, uncertainty with vaginal birth and positive views on CS. Interventions need to address these factors to reduce unnecessary CS.

Calificaciones y competencias en la producción gráfica universitaria uruguaya / Qualifications and competences in the university graphic production in Uruguay

La Universidad de la República, como organización del trabajo, reúne una serie de condiciones, tanto en lo que se refiere a sus formas de organización como a sus niveles de capacitación formal e informal, que constituyen un potencial positivo para implementar cambios que posibiliten una mayor profesionalización y procesos de mejora continua de sus funcionarios no-docentes. Pasar de una organización del trabajo estructurada en torno a un modelo de calificaciones a un modelo basado en las competencias, implica redefinir los saberes de los trabajadores en función de los objetivos institucionales y readecuar las tareas a partir de estos nuevos criterios. Este proceso será anlizado para las actividades de producción gráfica que realizan diferentes sectores de funcionarios universitarios, donde se implementan procesos cercanos a la actividad industrial, enmarcados en una lógica de servicios del sector público. Esta actividad és una combinación muy específica de actividades, que requeren diferentes niveles y tipos de competencias.(AU)