A longitudinal observational study of preference for elective caesarean section among nulliparous Hong Kong Chinese women

Abstract

Objective To establish whether women's preference for elective caesarean section (ELCS) changes as gestation advances.Design A prospective longitudinal observational study.Setting Two units providing obstetric care in Hong Kong, one public and one private.Sample Five hundred and one nulliparous Chinese pregnant women attending their routine fetal anomaly scan in either unit.Methods Consented subjects had two interviews using a structured questionnaire at 18-22 weeks and 35-37 weeks of gestation, respectively. Multivariate analysis was performed to identify determinants for preferring ELCS at the two gestational ages.Main outcome measure The preferences for the mode of delivery at the two gestational ages.Results The prevalence of maternal preference for ELCS in the study cohort was 17.2% (95% CI 13.9-20.5) and 12.7% (95% CI 9.6-15.8) at mid-trimester and at term, respectively. Significantly more women who preferred ELCS at mid-trimester changed to a trial of vaginal delivery (VD) at term than vice versa (42.0 versus 3.8%). The partner's preference for ELCS was a significant determinant for women preferring ELCS throughout the antenatal period. Among the women booked in the public sector, more women who preferred ELCS at term changed to deliver in private hospitals than those who preferred VD (46.2 versus 9.7%).Conclusions Many women changed from preferring ELCS to preferring VD as their pregnancy approached term. The partner's preference was a significant determinant for the women's choice. If a decrease in the proportion of women preferring ELCS is desired, the intervention programme should target the women and their partners who hold such a preference at 20 weeks.

Vaginal delivery compared with elective caesarean section: the views of pregnant women and clinicians

“…Most published papers have surveyed a variety of clinicians on their opinions about request for primary elective caesarean section, why they would agree to or refuse such a request and their practice patterns. 14,[17][18][19][20][21][22][23][24]29,30 There has been a questionnaire-based survey of women's views on elective caesarean section, 31 a longitudinal observational study to establish whether preference for elective caesarean section changes as gestation advances 32 and a critical review of the literature on request for caesarean section. 33 To our knowledge, this study is the first published paper to evaluate utility scores for the potential risks of VD, to compare women's and clinicians' views and to quantify the particular factors that would prompt a woman to request a primary elective caesarean section.…”

Technology Preference in Choices of Delivery Care Utilization from User Perspective –A Community Study in Vietnam

“…The women can also have a wish to deliver on a "good day" according to cultural beliefs [23]. In Asian countries, the partner's preference as well as that of the mother in law, also significantly influenced their choice [24].…”

Birth preferences by nulliparous women and their partners in Turkey

“…A lack of knowledge about childbirth, a negative image of giving birth and incorrect information cause fear, and this leads to women requesting a cesarean birth [12]. Other factors in the choice of a cesarean section are the idea that it is safer or healthier [7,9,10], avoiding damage to the body [6,9], the idea that it is safer for the baby [6,7], a recommendation by the doctor or midwife [8,13], planning the time of birth [8,10], and making a return to sexual activity easier [14] as well as if the doctor who is assisting at the birth is male [15].…”

“…The reasons that women choose a vaginal birth include a quicker recovery, the idea that it is healthier for the mother and baby [7,8,10,16], it allows breast-feeding sooner [7,14], it is more natural [7,8,16], it leads to a quicker discharge from hospital [10,14,17], it is less risky [10], and it is on the advice of the doctor or midwife [8].…”

“…Studies regarding women's choices in giving birth have shown that fear of childbirth is an important factor in their choice of cesarean section [5][6][7][8][9][10][11]. A lack of knowledge about childbirth, a negative image of giving birth and incorrect information cause fear, and this leads to women requesting a cesarean birth [12].…”