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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    • "Two dominant explanations for these decisions have been raised in the literature: women's preference for cesarean delivery and service providers' behaviors[6,7]. Although a number of studies have highlighted women's preference for elective cesarean section[8,9], there is little information regarding women's beliefs and attitudes towards vaginal delivery[10]. Most existing is quantitative, cross-sectional in nature, and mainly focuses on women's preference and associated factors derived from statistical analyses[11,12]. "
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    ABSTRACT: Childbirth by cesarean section has increased at an alarming rate over the past few years in Iran. The present study was designed to explore pregnant women’s beliefs about the mode of delivery in order to provide some suggestions for future interventions to increase vaginal delivery. This was a qualitative study framed by the Theory of Planned Behavior conducted in Tehran, Iran in 2013. Pregnant women attending public hospitals were recruited. The data were collected via in-depth interviews and focus group discussions. Interviews were conducted in a semi-structured manner. All interviews were tape recorded and transcribed verbatim. A content analysis approach was used to explore the data. In all 36 pregnant women participated in the study. The mean age of women was 27.8 (SD = 4.5) years. In general, women preferred vaginal delivery. During interviews and focus group discussions several themes emerged related to the pain associated with vaginal delivery, fears of childbirth, related health concerns, and the role of decision makers. The findings were grouped into three main themes namely: behavioral beliefs (negative and positive beliefs towards outcomes of vaginal delivery), normative beliefs (injunctive norms and descriptive norms), and control beliefs (internal and external barriers). Despite the fact that there were positive beliefs regarding vaginal delivery, participants indicated concerns related to loss of control and fear. It is essential that health care providers realize the psychological needs of women during pregnancy and the need for continuous support during childbirth. This type of support may improve their self-control during labor, and decrease fear of childbirth.
    Preview · Article · Dec 2015 · Reproductive Health
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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.
    Full-text · Article · Apr 2013 · International Journal of Reproductive BioMedicine
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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.
    Full-text · Article · Nov 2009 · Midwifery
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