Women’s cesarean section preferences and influencing factors in relation to China’s two-child policy: a cross-sectional study

Abstract

ObjectiveThis study explored women’s preference for cesarean section (CS) and the preference for cesarean sections’ influencing factors, particularly nonmedical factors.MethodsA cross-sectional study was conducted in four tertiary hospitals in Hohhot. We recruited 1,169 pregnant women at ≥ 28 gestational weeks and classified subjects into three groups by delivery mode preference: vaginal birth (VB), CS, and “no clear preference”. We identified the influencing factors of women’s choices by multinomial logistic regression. The adjusted relative-risk ratios (aRRRs) for the factors affecting the preference for CS and “no clear preference” categories and their 95% CIs were computed, using the preference for VB as the reference group.ResultsVB was preferred by 80.3% of the subjects, 8.8% preferred CS, and 10.9% had not decided yet. In the multinomial logistic regression, pregnant women intending to have more than one child were less likely to prefer CS (aRRR: 0.37; 95% CI: 0.22–0.61); choosing a lucky day for baby birth was the strongest factor for CS preference (aRRR: 12.36; 95% CI: 6.62–23.08), and other factors for CS preference were being aged 40 years and above (aRRR: 4.21; 95% CI: 1.43–12.40), being ethnic minority (aRRR: 2.00; 95% CI: 1.17, 3.41), feeling difficulty in getting pregnant (aRRR: 2.23; 95% CI: 1.20, 4.13), and having husband’s preference for CS (aRRR: 7.62; 95% CI: 4.00–14.54). The top reasons for preferring CS were the belief that CS was safer (51.5%), associated with less pain (40.8%), and better for baby’s and woman’s health (24.3% and 22.3%, respectively).ConclusionLess than one-tenth of the study subjects preferred CS. The cultural beliefs had the strongest influence on the decision of delivery mode. Those intending to have two or more children following the two-child policy were less likely to choose CS.

Preferences between Caesarean Section and Normal Vaginal Delivery among the reproductive women in Bangladesh

“…In this study majority of the women in Bangladesh preferred NVD and whereas only one in every fourteen women preferred CS, we also found the similar result in the other studies [7]; [24]; [25]. Almost four out of ten participants had no clear preference which is large comparing to the study conducted in China [26].…”

“…The result of logistic regression showed that mother's age has a significant effect on CS, however, a hospital-based study from china also showed higher CS rate for 40 years above old women [26]. Also, a population-based study from Taiwan reported that older than 34 years women were preferred CS for their child birth [27].…”

“…Some demographic data were provided by the participants, including age (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39), 40-49 years), place of residence (urban or rural), religion (Muslim and others), educational status (illiterate, primary, secondary and higher), working status (working or not), monthly household income (below 15,000, 15,000-40,000, 40,001-1,00,000 and above 1,00,000).…”

Factors influencing decision-making to accept elective caesarean section in a hospital in Ghana: A descriptive cross-sectional study

“…Other researchers have identi ed from the clinician's point of view what factors in uence the decision to perform caesarean section and found these to be the clinician's personal beliefs, health care systems factors and clinician's characteristics which includes con dence, skills and convenience [12]. On the other hand, in patient-initiated caesarean section, women make this decision based on maternal and infantrelated factors, social in uences, the certainty about the timing of the delivery, choosing a lucky day for baby birth and unpleasant experiences with previous vaginal delivery [13][14][15][16].…”

Materno-fetal and neonatal outcomes associated with caesarean section delivery in private and public hospitals in low- and middle-income countries: a systematic review

“…Li et al's retrospective cohort study demonstrated that trial of labour after caesarean delivery may be a potential strategy for decreasing the CSD rate [80]. This steady decline of CSD, particularly significant among nulliparous and multiparous births without a uterine scar, which is concomitant with a decline in perinatal mortality from 10.1 per 1,000 births to 7.2 per 1,000 births, is the result of institutional interventions and policy change [81]. While in Brazil, Galvao et al [82] propose the enforcement of Resolução Normativa 368, in addition to structural changes (e.g.…”