Influencing factors associated with the mode of birth among childbearing women in Hunan Province: a cross-sectional study in China

Abstract

BackgroundAn unnecessary Caesarean section (CS) can cause increased maternal and perinatal morbidity and other adverse short- and long-term outcomes. However, countries worldwide have witnessed an increasing trend toward the use of CS. Our objectives were to explore the influencing factors associated with the mode of birth among childbearing women in Hunan Province and to provide evidence and suggestions for the improvement and further understanding of vaginal birth (VB) in China.MethodsA total of 977 childbearing women (375 pregnant women and 602 mothers of infants) were enrolled in this study using a two-stage cluster sampling method, and a self-administered questionnaire was used to collect data relating to the mode of birth. A t-test and χ2-test were used to analyse the differences between groups, and logistic regression analysis was used to explore the factors that influenced the mode of birth.ResultsThe VB ratio was 46.2 %, while the CS ratio was 53.8 % in Hunan Province. Among women whose preference was VB, only 69.4 % gave birth by VB. Among women whose preference was CS, 98.1 % gave birth by CS. The top four reasons for preferring CS were a lack of confidence in VB (37.3 %), an abnormality in the prenatal examination (36.6 %), the notion that the baby would suffer fewer risks (34.8 %) and the fear of pain from VB (32.7 %). Age, prenatal examination, and doctors’ suggestion were significantly associated with women’s mode of birth preference, while place of household registration, husband’s preference, prenatal examination and doctors’ suggestion had a significant influence on women who changed their choice from VB to CS.ConclusionsThe percentage of CS in Hunan was extremely high. Medical factors, such as abnormalities in prenatal examinations, and non-medical factors, such as a lack of confidence in VB, the fear of pain during VB, the desire to select the time of birth and healthy birth systems, should be seriously considered. Targeted health promotion interventions should be implemented to improve the performance of VB.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-016-0897-9) contains supplementary material, which is available to authorized users.

Factors associated with Chinese pregnant women’s preference for a cesarean section based on the theory of planned behaviour

“…This study found that 20% of pregnant women would prefer to deliver by CS, a figure that is close to the results of studies from Beijing (19%) and Hunan Province (21%) in China . In addition, our study showed that 37% of multiparae and 9% of nulliparae preferred CS, while the corresponding results in a systematic review assessing the CS preference in pregnant women from multiple countries were 18% and 9% .…”

“…A structured, self‐administered questionnaire was used to collect information on pregnant women’s preferred mode of delivery, demographic characteristics, obstetric data, attitudes towards mode of delivery, childbirth self‐efficacy and subjective norms. The questionnaire was developed based on a review of previous literature , and 120 pregnant women were tested in a pilot study to ensure that the questions were clear and understandable to all participants.…”

“…Studies have revealed that a pregnant woman’s delivery preference is significantly associated with her actual mode of birth . Pregnant women preferring cesarean birth are more likely to undergo a cesarean section than those planning for vaginal delivery . Therefore, it is urgent and important to clarify factors related to pregnant women’s preferences for mode of delivery and to formulate targeted prenatal interventions, so as to reduce the high CS rate.…”

“…Therefore, it is urgent and important to clarify factors related to pregnant women’s preferences for mode of delivery and to formulate targeted prenatal interventions, so as to reduce the high CS rate. Previous studies suggested that pregnant women’s cognitive factors regarding childbirth, maternal age and obstetricians’ suggestions were associated with women’s preferences for mode of birth . However, most relevant studies were not conducted based on scientific theories and may result in a somewhat scattered picture.…”

Midwives’ and patients’ perspectives on disrespect and abuse during labor and delivery care in Ethiopia: a qualitative study

“…This low utilization in Ethiopia has been shown to be associated with women’s education levels, residence, ethnicity, parity, autonomy and household wealth, among other factors [ 18 – 20 ]. Studies in Ethiopia also show that perceptions of poor quality of care such as lack of privacy and lack of psychosocial support, are significant factors in a woman deciding whether or not to give birth at a health facility [ 21 , 22 ]. Furthermore, recent studies reveal evidence of disrespect and abuse in Ethiopian facilities [ 15 , 23 – 25 ].…”