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As negative birth experience predicts the wish for a CS, specific supportive care during first pregnancy could play a pivotal role in making this decision.

Aims: To assess pregnant women's awareness of and attitudes towards cesarean section (CS) on demand, as well as to identify specific target groups by focusing on differences dependant on the participants' background, parity and intended mode of delivery. Methods: The study was conducted at two centers during three months. German-speaking pregnant women were invited to answer an anonymous, structured questionnaire. We compared urban vs. rural, nulliparous vs. parous and women opting for a CS vs. denying this wish, with regard to awareness and attitudes towards CS on demand. Results: Ninety-two percent of the 201 participants were aware of the possibility to deliver by CS on demand. Their sources of information were mostly print media reports, television, or friends. Pain avoidance and missing the birth experience were the main reasons for and against CS on demand, respectively. For women opting for CS on demand, traumatically-experienced previous birth and the child's well-being were other important reasons for a CS. Conclusions: Because negative birth experience appears to be decisive for pregnant women's attitude towards CS on demand and their perception of CS seems to be partly based on misconceptions, antenatal counseling should focus on these aspects.

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