Obstetricians' judgments about cesarean request in ambiguous clinical cases vary considerably. Perceived risk of complaints and litigation is associated with compliance with the requested cesarean.

No abstract

C esarean section (CS) accounted for roughly 5% of all deliveries in the United States in 1970, and has increased to 32% of deliveries in 2007. A similar pattern of increase has been found in several European countries and this recent rise of CS is concerning to many obstetricians. From 4% to 18% of all CSs are performed at maternal request. The preference of CS versus vaginal delivery by mothers can be caused by a number of factors such as anxiety and fear of birth, previous cesarean delivery, previous negative birth experiences, maternal age, and socioeconomic dynamics. This study was conducted to provide a tool to predict which groups of women were more likely to prefer a CS.Data were collected from the Norwegian Mother and Child Cohort Study (MoBa), which consists of a database of >100,000 pregnancies which occurred between 1999 and 2008. Women were included if they responded to a question about their preference of delivery method; 58,881 women were included in the study (29,373 nulliparous and 29,508 multiparous). Socioeconomic information, obstetric and medical factors, emotional factors, and provider characteristics were all studied to identify their impact on delivery preference (outcome variable). Delivery preference was measured at 30 weeks gestation. First, the patients gave a response to the statement, "If I could choose, I would prefer to have a cesarean," on a 6-point response scale: agree completely, agree, agree somewhat, disagree somewhat, disagree, and disagree completely. Agree somewhat and disagree somewhat were excluded from the analysis (n = 7330) because preference of CS was unclear. Second, emotional variables were calculated on a 6-point scale based on the patients' responses to the statements, "I am really dreading giving birth," (fear of birth) "I worry all the time that the baby will not be healthy or normal," and "On the whole, I am satisfied with the way I have been followed by the health service." Previous delivery experiences were scored on a 5-point scale: very good, good, alright, bad, and very bad, and data on previous loss of a child were collected ("yes" or "no"). Background socioeconomic data including age ( < 35 y, Z35 y), marital status (married/cohabitant vs. no partner), education (secondary school, high school, higher education <4 y, higher education >4 y, other), work status (student, working, not working), smoking habits, income, and country of origin were gathered as well as data on preexisting maternal comorbidity: diabetes (preexisting or gestational), chronic diseases (ie, hypertension or epilepsy), and anxiety/depression. Obstetric risk factors included bleeding before week 28, in vitro fertilization and multiple pregnancy. The authors also took into account the type of antenatal care received: hospital clinic versus other (ie, midwife or general physician).A nulliparous and a multiparous "reference woman" were established. The nulliparous patient was defined as one without any of the risk factors commonly associated with a preference for a CS: <35 years, married ...

OBJECTIVE: To study factors related to preference for cesarean delivery, among pregnant women without medical complications. METHODS: A cross-sectional study was carried out among 156 pregnant women, in a private clinic in the city of Osasco, State of São Paulo, from October 2000 to December 2001. The pregnant women were at 28 weeks of pregnancy or more, with no formal contraindication for vaginal delivery at the time of the interview. Sociodemographic data and past and present obstetric history were assessed by applying a questionnaire. The pregnant women were specifically asked what their current preference for delivery was. Pearson's Chi-square test and logistic regression for multivariate analysis were performed with a 5% significance level. RESULTS: Sixty-seven pregnant women (42.9%) said they had little motivation to undergo vaginal delivery. In the multivariate analysis, the following variables were statistically significant: previous vaginal birth (p=0.001; ORadj=0.04; 95% CI=0.01-0.12); husband's monthly income greater than 750 reais (p=0.006, ORadj=3.44; 95% CI=1.38-8.33). The women with a previous vaginal delivery presented 25-fold lower chance of choosing cesarean delivery. The opinion that the previous delivery experience was unsatisfactory was marginally associated with the main outcome (p=0.06; ORadj=0.42; 95% CI=0.16-1.05). CONCLUSIONS: Motivation for cesarean delivery is associated with influences such as the type and degree of satisfaction with previous delivery and income.