Women’s preferences and mode of delivery in public and private hospitals: a prospective cohort study (original) (raw)
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2021
BackgroundThis paper reports on women's perspectives on the birth mode in five public maternity hospitals in Argentina. The study is a formative research study component aimed at tailoring interventions to reduce unnecessary caesarean section (CS) use. MethodsParticipants were postpartum women aged ≥15 years old in five hospitals in the provinces of Salta, Corrientes, Tucuman, Santa Fe and Buenos Aires City. Hospitals completed an institutional survey indicating the availability of obstetric services. The fieldwork was carried out from November 2018 to June 2019. Trained interviewers gathered data on obstetric history, companionship, mode of delivery preferences, and general opinion on vaginal and caesarean section births through semi-structured interviews. The interviews were coded and analysed with standard quantitative methods. ResultsThe five hospitals had a CS rate between 29.2 and 45.5. Four institutions indicated limited access to epidural and other pain management strate...
Preferences for mode of delivery in nulliparous Argentinean women: a qualitative study
Reproductive Health, 2013
Background: Over the last three decades, cesarean section (CS) rates have been rising around the world despite no associated improvement in maternal and perinatal mortality and morbidity. The role of women's preferences for mode of delivery in contributing to the high CS rate remains controversial; however these preferences are difficult to assess, as they are influenced by culture, knowledge of risk and benefits, and personal and social factors. In this qualitative study, our objective was to understand women's preferences and motivational factors for mode of delivery. This information will inform the development and design of an assessment aimed at understanding the role of the women's preferences for mode of delivery. Methods: We conducted 4 focus group discussions (FGDs) and 12 in-depth interviews with pregnant women in Buenos Aires, Argentina in 4 large non-public and public hospitals. Our sample included 29 nulliparous pregnant women aged 18-35 years old, with single pregnancies over 32 weeks of gestational age, without pregnancies resulting from assisted fertility, without known pre-existing medical illness or diseases diagnosed during pregnancy, without an indication of elective cesarean section, and who are not health professionals. FGDs and interviews followed a pre-designed guide based on the health belief model and social cognitive theory of health decisions and behaviors. Results: Most of the women preferred vaginal delivery (VD) due to cultural, personal, and social factors. VD was viewed as normal, healthy, and a natural rite of passage from womanhood to motherhood. Pain associated with vaginal delivery was viewed positively. In contrast, women viewed CS as a medical decision and often deferred decisions to medical staff in the presence of medical indication. Conclusions: These findings converge with quantitative and qualitative studies showing that women prefer towards VD for various cultural, personal and social reasons. Actual CS rates appear to diverge from women's preferences and reasons are discussed.
Women's Preference for Type of Delivery and Rates of Cesarean Sections in Brazil, 2010-2013
Open Access Journal of Gynecology and Obstetrics
Objective: To investigate an associations between women's preference for type of delivery and rates of cesarean section at the Hospital of the Federal University of Santa Catarina in 2010-2013. Methods: A cross-sectional study analyzed data from all deliveries occurred in a university hospital, in South Brazil, in this period. Results: The preference for cesarean delivery was reported by 15.3% of the 4,853 women in the study. The proportion of cesarean sections was higher among women with a preference for cesarean section (60.1%) compared to those prefering a normal delivery (31.1%). However, an association between the preference for cesarean delivery and the occurrence of this type of delivery was significantly mediated by age, previous cesarean section and early admission, after adjustment for these covariates (Non-adjusted PR=2,13(1,89;2,39) versus Adjusted PR=1,31(0,88-1,21). Conclusion: Women 's preference for the type of delivery at the university hospital did not play an important role in the final decision for type of delivery,at the study site.
BJOG : an international journal of obstetrics and gynaecology, 2018
To describe obstetrical providers' delivery preferences and attitudes toward caesarean section without medical indication, including on maternal request, and to examine the association between provider characteristics and preferences/attitudes. Cross-sectional study. Two public and two private hospitals in Argentina. Obstetrician-gynecologists and midwives who provide prenatal care and/or labor/delivery services. Providers in hospitals with at least 1,000 births per year completed a self-administered, anonymous survey. Provider delivery preference for low-risk women, perception of women's preferred delivery method, support for a woman's right to choose her delivery method and willingness to perform caesarean section on maternal request. One hundred and sixty-eight providers participated (89.8% coverage rate). Providers (93.2%) preferred a VD for their patients in the absence of a medical indication for caesarean section. While 74.4% of providers supported their patient&#...
Preference for caesarean attitudes toward birth in a Chilean sample of young adults
Women and Birth, 2019
Weeks, Fiona; Sadler, Michelle; Stoll, Kathrin Background: Little empirical research exists about what motivates birth mode preferences, and even less about this topic in Latin America, where obstetric interventions and caesareans are some of the highest worldwide. Aim: To identify factors associated with caesarean preference among Chilean men and women who plan to have children and to inform childbirth education and informed consent procedures. Methods: An online cross-sectional survey measuring attitudes toward birth was administered to graduate students at a large public university in Chile. Eligible students were under the age of 40 and had no children but intended to have children. Logistic regression modelling was used to determine which sociodemographic factors, knowledge and beliefs were associated with caesarean preference. Findings: Among eligible students, 730 responded and 664 provided complete answers to the variables of interest. Respondents had a mean age of 28.8; 38% were male and 62% female. Positive attitude toward technological intervention (Odds Ratio 7.4, 95% Confidence Interval 3.9-14.0), high risk perception of vaginal birth (Odds Ratio 1.8, 95% Confidence Interval 1.1-2.8), family history of caesarean (Odds Ratio 1.9, 95% Confidence Interval 1.0-3.8) and high fear of birth (Odds Ratio 3.7, 95% Confidence Interval 2.0-6.8) were associated with caesarean preference. Discussion: Preference for caesarean birth was highly associated with positive attitudes toward technological intervention and may be related to a lack of knowledge about the realities of caesarean and vaginal birth. Conclusions: Patient-centered education on the relative benefits and risks of birth modes has the potential to influence preferences toward vaginal birth. Statement of significance Problem or issue The 44.3% rate of caesarean birth in Latin America is higher than optimal for maternal and infant health. What is already known The attitudes and preferences of childbearing adults can influence the health care they receive, and therefore influence their health outcomes. What this paper adds Preferences for surgical birth are associated with a positive attitude toward technological medical intervention, with a high risk perception of vaginal birth, and with fear of birth. These associations are present among both men and women intending to have children.
2021
Background: This research explores women’s preferences for mode of birth (MOB) and their opinions on the advantages and disadvantages of MOB in public maternity hospitals with caesarean section (CS) rates higher than 30% in Argentina.Methods: Five public hospitals participated in this sequential mixed methods research. Post-partum women took part in semi-structured interviews which gathered information on obstetric history, MOB preferences, companionship, opinions on each MOB and if they would have liked to be asked about their MOB. The interviews were subsequently coded for quantitative analysis. A multiple regression model was run to explore variables associated with preferred MOB. Results: The interviews took place during eight weeks in 2019. The participating hospitals had limited availability to pain management interventions during birth. Participants were 621 women with a mean age of 26 +6. Forty percent had had a previous caesarean section (CS). Women gave birth accompanied i...
[Factors associated with preference for cesarean delivery]
Revista de Saúde Pública
To study factors related to preference for cesarean delivery, among pregnant women without medical complications. A cross-sectional study was carried out among 156 pregnant women, in a private clinic in the city of Osasco, State of São Paulo, from October 2000 to December 2001. The pregnant women were at 28 weeks of pregnancy or more, with no formal contraindication for vaginal delivery at the time of the interview. Sociodemographic data and past and present obstetric history were assessed by applying a questionnaire. The pregnant women were specifically asked what their current preference for delivery was. Pearson's Chi-square test and logistic regression for multivariate analysis were performed with a 5% significance level. Sixty-seven pregnant women (42.9%) said they had little motivation to undergo vaginal delivery. In the multivariate analysis, the following variables were statistically significant: previous vaginal birth (p=0.001; ORadj=0.04; 95% CI=0.01-0.12); husband'...
Determinants of women's preference for cesarean section
Texto & Contexto - Enfermagem, 2015
A qualitative, exploratory, descriptive, documentary, and retrospective research study to identify the determinants of women's preference for cesarean section. The information in this study is from the database extension project Group of Pregnant Women and Pregnant Couples by the Universidade Federal de Santa Catarina (1996-2013). We used the method of thematic analysis, from which emerged the Choice for Cesarean Section category, with three subcategories: who chooses cesarean section; preference for cesarean section defined during prenatal care; and possibility to choose cesarean section during labor. Of 169 postpartum women who had undergone a cesarean section, 16 chose the procedure. It was found that, in this group, the choice for cesarean section during prenatal care was influenced by the medical authority and, during labor, it was motivated by the prolonged duration and the pain caused by contractions. This study reinforced the importance of health education from the time ...