Preferences for mode of delivery in nulliparous Argentinean women: a qualitative study

Abstract

BackgroundOver the last three decades, cesarean section (CS) rates have been rising around the world despite no associated improvement in maternal and perinatal mortality and morbidity. The role of women’s preferences for mode of delivery in contributing to the high CS rate remains controversial; however these preferences are difficult to assess, as they are influenced by culture, knowledge of risk and benefits, and personal and social factors. In this qualitative study, our objective was to understand women’s preferences and motivational factors for mode of delivery. This information will inform the development and design of an assessment aimed at understanding the role of the women’s preferences for mode of delivery.MethodsWe conducted 4 focus group discussions (FGDs) and 12 in-depth interviews with pregnant women in Buenos Aires, Argentina in 4 large non-public and public hospitals. Our sample included 29 nulliparous pregnant women aged 18–35 years old, with single pregnancies over 32 weeks of gestational age, without pregnancies resulting from assisted fertility, without known pre-existing medical illness or diseases diagnosed during pregnancy, without an indication of elective cesarean section, and who are not health professionals. FGDs and interviews followed a pre-designed guide based on the health belief model and social cognitive theory of health decisions and behaviors.ResultsMost of the women preferred vaginal delivery (VD) due to cultural, personal, and social factors. VD was viewed as normal, healthy, and a natural rite of passage from womanhood to motherhood. Pain associated with vaginal delivery was viewed positively. In contrast, women viewed CS as a medical decision and often deferred decisions to medical staff in the presence of medical indication.ConclusionsThese findings converge with quantitative and qualitative studies showing that women prefer towards VD for various cultural, personal and social reasons. Actual CS rates appear to diverge from women’s preferences and reasons are discussed.

Obstetric violence: a new framework for identifying challenges to maternal healthcare in Argentina

“…51 A qualitative study of women's delivery preferences found that women in a public maternity facility were unaware that the mode of delivery was their choice; instead, they believed it to be a medical decision. 52 These studies reflect the fact that many physicians consider it unnecessary to inform women about their choices or show regard for their needs and preferences. The gender stereotyping exercised by physicians generalizes and pathologizes women's feelings and experiences in a way that strips women of power, decision-making and control over their own bodies.…”

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“…Improving the perceived quality of care of women ensures that the facility has the capacity of staff and resources to carry out safely and successfully CS. (Liu et al, (2013). Additional staff friendliness is an important building perceived quality of service not only, but also the choice of mode of delivery Yazdizadeh (2011),…”

“…Once the mother has chosen the right service provider, she made sure good professional responsible decisions in which the alternative delivery method would have been chosen as a last resort option to the satisfaction of the mother. Tian et al, (2014) Liu et al, (2013).…”

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“…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].…”