Women's Preference for a Cesarean Section: Incidence and Associated Factors

TLDR

Few studies have examined women's preferences for birth. The study aimed to determine the incidence of women’s preferred birth mode and the associated reasons and factors. The authors recruited 310 pregnant women at 36–40 weeks from a teaching hospital and six private obstetricians in Brisbane and collected questionnaire data on birth preferences, reasons, preparation, anxiety, and caregiver influence. Among 310 women, 93.5 % preferred spontaneous vaginal birth while 6.4 % preferred cesarean, and cesarean preference was linked to prior obstetric complications, higher anxiety, poor knowledge of risks, and previous cesarean experience, indicating that reducing primary cesarean rates and improving emotional support and risk communication may lower cesarean preference.

Abstract

Few studies have examined women's preferences for birth. The object of this study was to determine the incidence of women's preferred type of birth, and the reasons and factors associated with their preference.Three hundred and ten women between 36 and 40 weeks' gestation were recruited from the antenatal clinic of a major metropolitan teaching hospital and the consulting rooms of six private obstetricians in Brisbane, Australia. Participants completed a questionnaire asking about their preferred type of birth, reasons for their preference, preparation for childbirth, level of anxiety and concerns, and the influence of the primary caregiver.Two hundred and ninety women (93.5%) preferred a spontaneous vaginal birth; 20 women (6.4%) preferred a cesarean section. Of the latter group, most had a current obstetric complication or experienced a previously complicated delivery (p <0.001); 1 woman (0.3%) preferred a cesarean section in the absence of any known current or previous obstetric complication. Women who preferred a cesarean section were more anxious, were generally poorly informed of the risks of this procedure, and/or overestimated the safety of the procedure.Women who preferred a cesarean section were more likely to have experienced this type of birth previously and to have negative feelings about it. To decrease women's preference for a cesarean section, practitioners should reduce the primary cesarean delivery rate and improve the quality of emotional care for women who require a cesarean section. Caregivers should engage in a sensitive discussion of the risks and benefits of various birth options, including a vaginal birth after cesarean, with women who have previously experienced a cesarean birth before they make decisions about mode of delivery in a subsequent pregnancy.