“Because it eases my Childbirth Plan”: a qualitative study on factors contributing to preferences for caesarean section in Thailand

Abstract

Background Although caesarean section (CS) rates have increased rapidly in Thailand, the upward trend is not supported by significant maternal or perinatal health benefits. The appropriate use of CS through QUALIty DECision-making by women and providers (QUALI-DEC project) aims to design and implement a strategy to optimize the use of CS through non-clinical interventions. This study aimed to explore the factors influencing women’s and health professionals’ preferences for CS delivery in Thailand. Methods We conducted a formative qualitative study by using semi-structured in-depth interviews with pregnant and postpartum women, and healthcare staff. Purposive sampling was used to recruit participants from eight hospitals across four regions of Thailand. Content analysis was used to develop the main themes. Results There were 78 participants, including 27 pregnant and 25 postpartum women, 8 administrators, 13 obstetricians, and 5 interns. We identified three main themes and seven sub-themes of women and healthcare providers’ perceptions on CS: (1) avoiding the negative experiences from vaginal birth (the pain of labor and childbirth, uncertainty during the labor period); (2) CS is a safer mode of birth (guarantees the baby’s safety, a protective shield for doctors); and (3) CS facilitates time management (baby’s destiny at an auspicious time, family’s management, manage my work/time). Conclusions Women mentioned negative experiences and beliefs about vaginal delivery, labor pain, and uncertain delivery outcomes as important factors influencing CS preferences. On the other hand, CS is safer for babies and facilitates multiple tasks in women’s lives. From health professionals’ perspectives, CS is the easier and safer method for patients and them. Interventions to reduce unnecessary CS, including QUALI-DEC, should be designed and implemented, taking into consideration the perceptions of both women and healthcare providers.

Comparison of perinatal outcome and mode of birth of twin and singleton pregnancies in migrant and refugee populations on the Thai Myanmar border: A population cohort

“…The marginalized population reported here are receiving cross-border care in a setting with high and growing rates of caesarean delivery in Thailand. Meanwhile, Myanmar is in the midst of another coup which seriously and negatively impacts access to maternal health services including contraception and delivery services, with implications for future safety for a woman with a uterine scar [ 43 ].…”

Evaluation of cesarean delivery rates and factors associated with cesarean delivery among women enrolled in a pregnancy cohort study at two tertiary hospitals in Thailand

“…These findings are consistent with another study [ 28 ] among Thai mothers which also found that willingness to pay for delivery fees led to an increased likelihood of cesarean delivery. While our study did not examine factors contributing to patients’ preferences for cesarean delivery, a recent qualitative study among Thai women revealed that the reasons for such action were largely centered on the convenience of cesarean delivery to schedule birth, avoid labor pain, and ensure perceived safe childbirth [ 29 ].…”

How does hospital organisation influence the use of caesarean sections in low- and middle-income countries? A cross-sectional survey in Argentina, Burkina Faso, Thailand and Vietnam for the QUALI-DEC project

“…These finding are consistent with the results of previous studies in similar context [ 13 , 36 – 38 ]. Most pre-labour CS were performed in Argentina and Thailand, countries where women’s preference for a pre-labour CS seems to be marked, revealed by women and accepted by obstetricians [ 39 – 41 ]. This is correlated with our findings which show that crude odds ratios of intrapartum CS are usually equal or smaller than those of pre-labour CS and that more than 30% of pre-labour CS were performed on maternal request in our sample.…”