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.
Highlights
An unnecessary Caesarean section (CS) can cause increased maternal and perinatal morbidity and other adverse short- and long-term outcomes
Our objectives aimed to explore the influencing factors associated with mode of birth, especially women’s preference and willingness before childbirth and their actual decision, among childbearing women in Hunan Province and to provide evidence and suggestions for improvement and further understanding of vaginal birth (VB) in China
These results suggested that CS may not be their first choice, and other influencing factors in the pregnancy process contributed to their mode of birth change
Summary
An unnecessary Caesarean section (CS) can cause increased maternal and perinatal morbidity and other adverse short- and long-term outcomes. A Caesarean section (CS) can save lives and prevent injuries in circumstances such as dystocia, malpresentation and foetal distress [1, 2], which occur in approximately 5–15 % of pregnancies [3]. An unnecessary CS can cause additional maternal and perinatal morbidity in cases such as postpartum haemorrhaging, reduced fertility and placental complications in subsequent pregnancies for mothers. In rural China, the CS rate increased from 6 to 26 % between 1998 and 2007 [13], while in urban areas, it increased from 18.2 % in 1990-92 to 39.5 % in 1998–2002 [14]. By 2007-08, the average CS rate in China had increased to 46.2 % [15]
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