Reasons for Increased Caesarean Section Rate in Vietnam: A Qualitative Study among Vietnamese Mothers and Health Care Professionals

Abstract

The Caesarean section rate in urban Vietnam is 43% in 2014, which is more than twice the recommended rate (10%–15%) by the World Health Organization. This qualitative study aims to identify the perceptions of pregnant mothers and health care professionals on the medical and social factors related to the increased Caesarean section rate in Vietnam. A qualitative descriptive study was conducted among pregnant mothers and healthcare professionals at two public hospitals in Nha Trang city. A content analysis was adopted in order to identify social and medical factors. As a result, 29 pregnant women and 19 health care professionals were invited to participate in the qualitative interviews. Private interviews were conducted with 10 women who wished to have a Caesarean section, and the others participated in focus group interviews. The main themes of the social factors were ‘request for Caesarean section,’ ‘mental strain of obstetricians,’ and ‘decision-making process.’ To conclude, this qualitative study suggests that there were unnecessary caesarean sections without a clear medical indication, which were requested by women and family members. Psychological fear occurred among women and family, and doctors were the main determinants for driving the requests for Caesarean section, which implies that education and emotional encouragement is necessary by midwives. In addition, a multi-faced approach including a mandatory reporting system in clinical fields and involving family members in antenatal education is important.

Women’s empowerment and elective cesarean section for a single pregnancy: a population-based and multivariate study in Vietnam

“…This interpretation is further updated and strengthened by a new emphasis on "population quality" [34]. In addition, specific sociocultural factors in favor of CS have been reported, such as a search for a propitious day [24] and a preference for sons in some areas of the country [35]. Women's requests may result from a power dynamic between members of the women's family and available economic resources at the household level.…”

“…A high level of childbirth biomedicalization contributes to this trend in the context of persistent gender inequality despite political commitment to women's empowerment [22,23]. Qualitative studies emphasize the fear of childbirth as a major determinant of maternal requests for CS in the absence of effective pharmacological pain relief and a lack of social support during labor [24,25]. Empowered women may be more able to request CS.…”

A Cross-Sectional Study Examining Differences in Indication for Cesarean Delivery by Race/Ethnicity

“…Because of the small number of maternal (N = 11), fetal (N = 17), and obstetric (N = 19) conditions, these indications were grouped together under the “other” category, reducing the total number of categories to six. While cesarean delivery on maternal request absent of a medical indication may be an issue in some contexts, it is relatively limited (about 2.5% of births) in the U.S. [ 24 ] and was not noted as an indication in any of the records reviewed for this study [ 25 , 26 ]. Indications were also recoded into a dichotomous variable of subjective (NRFHT and arrest of labor) and objective (all other indications).…”

Do women prefer caesarean sections? A qualitative evidence synthesis of their views and experiences

“…Finding 1: Deep rooted fears regarding vaginal birth (High confidence). Some women experienced strong fear of pain and injuries to the mother and child during labor and birth [24,29,30,33,36,41,49,50,52,55,[58][59][60][61]65,[67][68][69][70][71][72]74]. It was described consistently as a reason for CS on maternal request.…”