Abstract
This research examines whether maternal optimism/pessimism is associated with unplanned Cesarean section deliveries in China. If so, does the association remain after controlling for clinical factors associated with C-sections? A sample of 227 mostly primiparous women in the third trimester of pregnancy was surveyed in a large tertiary care hospital in Beijing, China. Post-delivery data were collected from medical records. In bivariate analysis, both optimism and pessimism were related to unplanned c-section. However, when optimism and pessimism were entered into a regression model together, optimism was no longer statistically significant. Pessimism remained significant, even when adjusting for clinical factors such as previous abortion, previous miscarriage, pregnancy complications, infant gestational age, infant birthweight, labor duration, birth complications, and self-rated difficulty of the pregnancy. This research suggests that maternal mindset during pregnancy has a role in mode of delivery. However, more research is needed to elucidate potential causal pathways and test potential interventions.
Highlights
IntroductionCesarean section rates are increasing [1,2,3]. Despite recommendations that cesarean section rates not exceed 15% [4, 5], many countries have rates double or even triple that threshold [3]
Worldwide, Cesarean section rates are increasing [1,2,3]
(1) Is generalized maternal optimism or pessimism associated with unplanned cesarean section among women giving birth in a tertiary care hospital in Beijing? (2) If optimism or pessimism is associated with unplanned cesarean section, which is more strongly associated, optimism or pessimism? And (3) if there is a significant relationship between optimism, pessimism, and unplanned cesarean section delivery, is that relationship robust enough to remain significant when clinical factors are included in the model?
Summary
Cesarean section rates are increasing [1,2,3]. Despite recommendations that cesarean section rates not exceed 15% [4, 5], many countries have rates double or even triple that threshold [3]. Cesarean section deliveries can be lifesaving for both mothers and their infants when indicated, their overuse is cause for concern due to their association with increased maternal morbidity and mortality, cost, and utilization of sometimes scarce health system resources [3]. Numerous researchers have investigated the predictors of higher than normal cesarean section rates [9,10,11,12,13,14,15]. Principal among these include including physician-related factors, insurancerelated factors, hospital and health-system factors, and maternal preferences. Cesarean section rates have been found to vary by male versus female provider [15], public versus private hospital setting [16,17,18,19], adoption
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