Comfort or necessity: obstetricians’ perspectives on the drivers, consequences, and recommendations for reducing caesarean section rates in Turkey

Caesarean section (CS) is life-saving when clinically indicated; however, Turkey’s CS share ranks near the top globally, indicating potential overuse. This qualitative study, using a descriptive phenomenological design, explored obstetricians’ perspectives on the drivers of rising CS rates, the consequences of non-indicated CS, and feasible strategies to reduce overuse. Between March and June 2025, 40 obstetricians were recruited via purposive, maximum-variation sampling from public, training & research (university), and private hospitals across multiple regions of Turkey. Semi-structured, web-based interviews (Zoom/Google Meet) were audio-recorded with consent and transcribed verbatim. Data were analysed in MAXQDA 10 using inductive, conventional qualitative content analysis, with codes derived directly from the data, organised into categories, and developed into themes and subthemes. Analysis identified three overarching themes comprising 13 subthemes. Theme 1—Drivers of rising CS: medico-legal anxiety and defensive practice; convenience, scheduling and workflow pressures; declining confidence with complex vaginal births; technology-centred surveillance; expectations for planned/painless birth shaped by families and social media; and financial/payment signals in mixed public–private provision. Theme 2—Consequences and the “comfort versus necessity” paradox: maternal and neonatal risks (including infection, thrombo-embolism, adhesions and early-elective CS–related respiratory morbidity), ethical distress among clinicians, erosion of vaginal-birth skills, and increased system costs with potential equity impacts. Theme 3—Participant-reported strategies to reduce unnecessary CS: coordinated actions spanning malpractice protections/safe harbours; payment redesign (e.g. bundled/global models that value labour support) with Robson audit-and-feedback; scaling nursing-midwife-led continuity of care; 24/7 labour analgesia; strengthened vaginal birth after caesarean pathways; and antenatal education that involves partners alongside balanced public communication. Obstetricians located CS overuse chiefly within sociocultural, legal, organisational and incentive structures, rather than clinical necessity. A multi-component, system-level response—aligning medico-legal frameworks, financing that rewards labour support, nursing-midwifery workforce models, round-the-clock analgesia, and patient-facing education—appears essential to normalise safe, respectful vaginal birth and curb unnecessary CS.