Abstract Background. C-section rate in Romania is the second-highest in the European Union (44.1% in 2017) and the number of C-sections performed in the country increased by 32.1% between 2009 and 2017. We offer for the first time insights into the practice and perceptions of patients and doctors in Romania towards delivery mode and on health system particularities that lead to increased numbers of C-sections. The objectives are 1) to compare the preferred modes of birth among women 2) to draw a profile of patients in whose case the actual birth method is different from the preferred method, and 3) to outline a profile of doctors and patients based on the modes of delivery. Methods. We conduct a statistical analysis based on an observational, analytical, and cross-sectional survey on 117 singleton pregnant women more than 36 weeks in spontaneous labor in tertiary level maternity in Romania. Various statistical tests have been used to indicate statistical significance. Results. Our results show an increase of almost 58% in actual childbirth mode against preferred childbirth by C-sections, rather difficult to justify based only on medical emergencies. There are 22 patients with non-concordant C-section indications between preferred and actual mode of birth, 7 of them (31.8%) preferred natural birth and 15 (68.2%) preferred C-section. Scarred uterus is the most frequent medical indication for C-section (30.7%). Overall, birth and birth pain assessment correlates to preferred and actual delivery modes, but respondents distinguish clearly between birth pain alone and their overall birth experience. The profiles of patients with concordant and non-concordant delivery modes are different, and indicate a statistically significant difference between the preference for delivery and actual birth method. Patients who preferred vaginal birth, but gave birth by C-section, are mature and more educated women, in the middle to the high-income category, mostly attended by consultant doctors and specialists. Doctors’ profiles show that specialists and consultants attend the largest share of non-concordant births, while residents and young senior doctors attend mostly vaginal births. Conclusions. We emphasize health system particularities in Romania as triggers of high C-section rates that favor womens’ preferences against C-section medical indication.

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