Healthcare professionals’ perceptions of caesarean section decision-making and the implementation of Audit&Feedback strategies in the Calabria Region: a qualitative study

Introduction. Calabria Region has one of the highest caesarean section (CS) rate in Italy. To encourage the implementation of Audit&Feedback strategies, this study aimed to explore factors influencing CS decision-making from healthcare professionals’ perspectives. Method. A descriptive qualitative study was conducted through focus groups (FGs) with healthcare professionals (HPs) from 11 Maternity Units and 3 Community Health Services for Families of Calabria, from February to April 2021. Results. Six FGs were carried out, involving 92 HPs. Main determinants influencing high CS rates included medicalization of birth, reported women’s fear of childbirth, family pressure, cultural beliefs, organizational issues, and medico-legal concerns. HPs emphasized teamwork, midwifery-led low-risk pathways, training, and audits to reduce CS rates and improve quality of care. Conclusions. This study identified determinants influencing CS decision-making in Calabria highlighting opportunities to reduce CS through empowering education, shared protocols, and women’s active involvement in decision-making process. Audit&Feedback strategies could improve health outcomes.