Women’s preferences and mode of delivery in public and private hospitals: a prospective cohort study

Abstract

BackgroundRates of caesarean section have steadily increased in most middle- and high-income countries over the last few decades without medical justification. Maternal request is one of the frequently cited non-medical factors contributing to this trend. The objectives of this study were to assess pregnant women’s preferences regarding mode of delivery and to compare actual caesarean section rates in the public and private sectors.MethodsA prospective cohort study was conducted in two public and three private hospitals in Buenos Aires, Argentina. 382 nulliparous pregnant women (183 from the private sector and 199 from the public sector) aged 18 to 35 years, with single pregnancies over 32 weeks of gestational age were enrolled during antenatal care visits between October 2010 and September 2011. We excluded women with pregnancies resulting from assisted fertility, women with known pre-existing major diseases or, with pregnancy complications, or with a medical indication of elective cesarean section. We used two different approaches to assess women’s preferences: a survey using a tailored questionnaire, and a discrete choice experiment.ResultsOnly 8 and 6 % of the healthy nulliparous women in the public and private sectors, respectively, expressed a preference for caesarean section. Fear of pain and safety were the most frequently expressed reasons for preferring caesarean section. When reasons for delivery mode were assessed by a discrete choice experiment, women placed the most emphasis on sex after childbirth. Of women who expressed their preference for vaginal delivery, 34 and 40 % ended their pregnancies by caesarean section in public and private hospitals, respectively.ConclusionsThe preference for caesarean section is low among healthy nulliparous women in Buenos Aires. The reasons why these women had a rate of more than 35 % caesarean sections are unlikely related to their preferences for mode of delivery.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-016-0824-0) contains supplementary material, which is available to authorized users.

Obstetrical providers’ preferred mode of delivery and attitude towards non‐medically indicated caesarean sections: a cross‐sectional study

“…Of a sample of low-risk, nulliparous, private-sector Argentine women preferring VD in their third trimester, 11% had a documented scheduled CS, 13% of which had medical indications. 25 Of a sample of private-sector Brazilian women preferring VD during their third trimester, 34% delivered via scheduled CS. 34 …”

“…We are grateful to Dr Agustina Mazzoni (IECS) for sharing survey instruments and other materials used in her study. 25 We could not have done this study without the collaboration and dedication of the Feasibility of ‘Mode of Delivery Trial’ Study Group .…”

Determinants and materno-fetal outcomes related to cesarean section delivery in private and public hospitals in low- and middle-income countries: a systematic review and meta-analysis protocol

“…Other sources point to the role of supplier-side demand induction behavior [27, 28]. From a consumer perspective, some authors have suggested that women request to have an elective CSD in the absence of clinical indications [29–32]. However, McCourt et al’s critical review [33] found that women’s preference for CSD varied only from 0.3 to 14%.…”

Factors affecting the decision of women on the type of delivery

“…'nın 13 yapmış olduğu bir çalışmada yaş ve eğitim durumu arttıkça kadınların sezaryen doğuma eğilimlerinin arttığı gösterilmişken çalışma-mızda yaş ile birlikte sezaryen doğuma eğilim olduğu görülmekle birlikte eğitim durumu ile doğum tercihleri arasında bir ilişki belirlenmedi. İleri maternal yaş ile sezaryen doğuma eğilimin artmasının nedeni, kadınların daha fazla sosyal yaşamın içine girmesiyle birlikte çocuk sahibi olmanın geciktirilmesi, dolayısı ile daha ileri yaşlardaki anne adaylarının doğumun daha planlı ve kontrollü hale getirme isteği olabilir.…”