Determinants of preference for elective caesarean section in Hong Kong Chinese pregnant women

Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
Hong Kong medical journal = Xianggang yi xue za zhi / Hong Kong Academy of Medicine (Impact Factor: 0.87). 05/2007; 13(2):100-5.
Source: PubMed


To find the clinical and socio-demographic determinants for Hong Kong Chinese women who preferred elective caesarean section.
Cross-sectional interview survey.
University teaching hospital, Hong Kong.
A cohort of consecutive Hong Kong Chinese pregnant women (n=660) attending a government-funded obstetric unit catering deliveries in the New Territories in Hong Kong in 2002.
The clinical and socio-demographic determinants of preference for elective caesarean section, in women who could have a trial of vaginal delivery.
The overall prevalence for maternal preference for elective caesarean section was 16.7% (95% confidence interval, 13.8-19.6). The factors associated with preferring elective caesarean section were: previous elective caesarean section (odds ratio=7.6; 95% confidence interval, 2.0-28.7) and previous emergency caesarean section (3.8; 1.8-8.2). Among nulliparous women, the prevalence of preference for elective caesarean section was 16.8% (95% confidence interval, 13.0-20.6). Conception by in-vitro fertilisation was found to be significantly associated with preferring elective caesarean section in nulliparous women (odds ratio=5.2; 95% confidence interval, 1.0-26.4).
Previous caesarean section and conception by in-vitro fertilisation were determinants for women preferring elective caesarean section.

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    • "According to the results of this study, 81.4% of pregnant women in first pregnancy said that they preferred to have VD by the end of the pregnancy period while 18.6% of them preferred to have CD. In two studies that conducted in Hong Kong and Norway, 16.8% and 2.4% of nulliparous women said they would prefer for their baby to be delivered by Cesarean (31, 33). In Mohammadbeigi et al that conducted in south of Iran (Shiraz) 50.7% of nulliparous women preferred CD but in Mohammadpour et al study which conducted in northwest of Iran (Maragheh) 29.6% of nulliparous women preferred CD (42, 43). "
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    ABSTRACT: Background: The increasing number of cesarean section is a great concern in many countries. In Iran cesarean section rate has been steadily rising from 35% in 2000 to 40% in 2005. Preferences for cesarean are often associated with some factors. Objective: To investigate factors associated with preference for cesarean delivery, with special emphasis on pregnant women’s preferences in first pregnancy in Neyshabur (Northeast of Iran). Materials and Methods: In this cross-sectional study, written questionnaires were completed via face to face interview with 797 pregnant women in first pregnancy. Socio-demographic data, preference toward mode of delivery and factors associated with it were assessed by applying questionnaire. Univariate and multivariate analysis were performed to identify the independent variables associated with preference for cesarean delivery. Results: In this study observed that 18.6% of pregnant women preferred caesarean delivery in first pregnancy. The mean age of pregnant women that they preferred cesarean delivery was upper than pregnant women that they preferred vaginal delivery and this difference was statistically significant (p=0.006). There was a statistically significant relation between preference for cesarean delivery and the following variables: educational level (p<0.001), gestational age (p=0.003) spouse’s age of pregnant women (p=0.001), physician’s advice (p<0.001), and fear of delivery (p<0.001). Conclusion: The results of this study show that the majority of pregnant women do not prefer caesarean delivery to vaginal delivery. Nevertheless the preference rate for cesarean delivery exceeded 15% that suggested by WHO and most important factors in pregnant women prefer cesarean deliveries are fear of delivery and physician’s advice.
    Iranian Journal of Reproductive Medicine 04/2013; 11(4):301-8. · 0.19 Impact Factor
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    • "Perceived risks of vaginal birth include prolonged labour, physical trauma and concern for fetal well-being (Quinlivan et al., 1999; Edwards and Davies, 2001; Hildingsson et al., 2002; Pakenham et al., 2006; Waldenströ m et al., 2006; Wiklund et al., 2008). In non-Western populations, a wish to avoid pain, previous caesarean section, having conceived with the aid of reproductive technology, and fear of sub-standard care were the primary rationales offered by women who preferred a caesarean section (Bé hague et al., 2002; Lei et al., 2003; Angeja et al., 2006; Pang et al., 2007). It is suggested that the phenomenon might also be explained as a marker of women's empowerment and social status in an age of consumerism (Bryant et al., 2007; Andrist, 2008). "
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    ABSTRACT: a growing number of childbearing women are reported to prefer a caesarean section in the absence of a medical reason. Qualitative research describing factors influencing this preference in pregnant women is lacking. to describe Australian women's request for caesarean section in the absence of medical indicators in their first pregnancy. advertisements were placed in local newspapers inviting women to participate in a telephone interview exploring women's experience of caesarean section. Thematic analysis was used to analyse data. two states of Australia: Queensland and Western Australia. a community sample of women (n=210) responded to the advertisements. This paper presents the findings elicited from interviews conducted with 14 women who requested a caesarean section during their first pregnancy in the absence of a known medical indication. childbirth fear, issues of control and safety, and a devaluing of the female body and birth process were the main themes underpinning women's requests for a non-medically-indicated caesarean section. Women perceived that medical discourses supported and reinforced their decision as a 'safe' and 'responsible' choice. KEY CONCLUSIONS AND RECOMMENDATIONS FOR PRACTICE: these findings assist women and health professionals to better understand how childbirth can be constructed as a fearful event. In light of the evidence about the risks associated with surgical birth, health-care professionals need to explore these perceptions with women and develop strategies to promote women's confidence and competence in their ability to give birth naturally.
    Midwifery 11/2009; 26(4):394-400. DOI:10.1016/j.midw.2008.10.011 · 1.57 Impact Factor
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    • "While clearly a controversial issue, the choice to undergo elective CS is being exercised to varying degrees by women in Canada and internationally [15,17,44-47]. This study represents a preliminary but integral step to help ensure women considering delivery approaches in uncomplicated pregnancies are fully informed. "
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    ABSTRACT: The rate of caesarean sections is increasing worldwide, yet medical literature informing women with uncomplicated pregnancies about relative risks and benefits of elective caesarean section (CS) compared with vaginal delivery (VD) remains scarce. A decision board may address this gap, providing systematic evidence-based information so that patients can more fully understand their treatment options. The objective of our study was to design and pre-test a decision board to guide clinical discussions and enhance informed decision-making related to delivery approach (CS or VD) in uncomplicated pregnancy. Development of the decision board involved two preliminary studies to determine women's preferred mode of risk presentation and a systematic literature review for the most comprehensive presentation of medical risks at the time (VD and CS). Forty women were recruited to pre-test the tool. Eligible subjects were of childbearing age (18-40 years) but were not pregnant in order to avoid raising the expectation among pregnant women that CS was a universally available birth option. Women selected their preferred delivery approach and completed the Decisional Conflict Scale to measure decisional uncertainty before and after reviewing the decision board. They also answered open-ended questions reflecting what they had learned, whether or not the information had helped them to choose between birth methods, and additional information that should be included. Descriptive statistics were used to analyse sample characteristics and women's choice of delivery approach pre/post decision board. Change in decisional conflict was measured using Wilcoxon's sign rank test for each of the three subscales. The majority of women reported that they had learned something new (n = 37, 92%) and that the tool had helped them make a hypothetical choice between delivery approaches (n = 34, 85%). Women wanted more information about neonatal risks and personal experiences. Decisional uncertainty decreased (p < 0.001) and perceived effectiveness of decisions increased (p < 0.001) post-intervention. Non-pregnant women of childbearing age were positive about the decision board and stated their hypothetical delivery choices were informed by risk presentation, but wanted additional information about benefits and experiences. This study represents a preliminary but integral step towards ensuring women considering delivery approaches in uncomplicated pregnancies are fully informed.
    BMC Pregnancy and Childbirth 10/2009; 9(1):50. DOI:10.1186/1471-2393-9-50 · 2.19 Impact Factor
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