Low use of vacuum extraction: Health care Professionals’ Perspective in a University Hospital, Dar es Salaam

• Published in: Sexual & reproductive healthcare 2020-10, Vol.25, p.100533-100533, Article 100533
• Main Authors: Makokha-Sandell, Henrik, Mgaya, Andrew, Belachew, Johanna, Litorp, Helena, Hussein, Kidanto, Essén, Birgitta
• Format: Article
• Language: English
• Subjects: Caesarean section; Low-income setting; Tanzania; Vacuum extraction
• ISSN: 1877-5756; 1877-5764; 1877-5764
• DOI: 10.1016/j.srhc.2020.100533

•Lack of practical skills hinder vacuum extraction use.•Unstructured and inconsistent teaching structure cause low use of vacuum extraction.•Fear and blame of poor outcome preference caesarean section over vacuum extraction.•Financial incentives preference caesarean section over alternative methods.•Poor integrative communication cause absent teachers and unaccountable students. Use of vacuum extraction (VE) has been declining in low and middle income countries. At the highest referral hospital Tanzania, 54% of deliveries are performed by caesarean section (CS) and only 0.8% by VE. Use of VE has the potential to reduce CS rates and improve maternal and neonatal outcomes but causes for its low use is not fully explored. During November and December of 2017 participatory observations, semi-structured in-depth interviews (n = 29) and focus group discussions (n = 2) were held with midwives, residents and specialists working at the highest referral hospital in Tanzania. Thematic analysis was used to identify rationales for low VE use. Unstructured and inconsistent clinical teaching structure, interdependent on a fear and blame culture, as well as financial incentives and a lack of structured, adhered to and updated guidelines were identified as rationales for CS instead of VE use. Although all informants showed positivity towards clinical teaching of VE, a subpar communication between clinics and academia was stated as resulting in absent clinical teachers and unaccountable students. This study draws connections between the low use of VE and the inconsistent and unstructured clinical training of VE expressed through the health care providers’ points of view. However, clinical teaching in VE was highly welcomed by the informers which may serve as a good starting point for future interventions.