Abstract
BackgroundEfforts to reduce unnecessary Cesarean sections (CS) in high and middle income countries have focused on changing hospital cultures and policies, care provider attitudes and behaviors, and increasing women’s knowledge about the benefits of vaginal birth. These strategies have been largely ineffective. Despite evidence that women have well-developed preferences for mode of delivery prior to conceiving their first child, few studies and no interventions have targeted the next generation of maternity care consumers. The objectives of the study were to identify how many women prefer Cesarean section in a hypothetical healthy pregnancy, why they prefer CS and whether women report knowledge gaps about pregnancy and childbirth that can inform educational interventions.MethodsData was collected via an online survey at colleges and universities in 8 OECD countries (Australia, Canada, Chile, England, Germany, Iceland, New Zealand, United States) in 2014/2015. Childless young men and women between 18 and 40 years of age who planned to have at least one child in the future were eligible to participate. The current analysis is focused on the attitudes of women (n = 3616); rates of CS preference across countries are compared, using a standardized cohort of women aged 18–25 years, who were born in the survey country and did not study health sciences (n = 1390).ResultsOne in ten young women in our study preferred CS, ranging from 7.6% in Iceland to 18.4% in Australia. Fear of uncontrollable labor pain and fear of physical damage were primary reasons for preferring a CS. Both fear of childbirth and preferences for CS declined as the level of confidence in women’s knowledge of pregnancy and birth increased.ConclusionEducation sessions delivered online, through social media, and face-to-face using drama and stories told by peers (young women who have recently had babies) or celebrities could be designed to maximize young women’s capacity to understand the physiology of labor and birth, and the range of methods available to support them in coping with labor pain and to minimize invasive procedures, therefore reducing fear of pain, bodily damage, and loss of control. The most efficacious designs and content for such education for young women and girls remains to be tested in future studies.
Highlights
Efforts to reduce unnecessary Cesarean sections (CS) in high and middle income countries have focused on changing hospital cultures and policies, care provider attitudes and behaviors, and increasing women’s knowledge about the benefits of vaginal birth
In this paper we argue that interventions aimed at reducing the Cesarean section rate should begin before women and men become parents, because attitudes towards birth are developed in advance of pregnancy and might be influenced by modifiable factors such as childbirth fear and lack of knowledge of pregnancy and birth
Given the iatrogenic morbidities and increased cost associated with unnecessary CS [1], the limited effectiveness of strategies aimed at care providers, pregnant women and institutional structures, and evidence of well-developed birth preferences expressed by young women prior to pregnancy, the objectives of this study were to examine 1) preferences for Cesarean section in a hypothetical healthy pregnancy among young women from 8 Organisation for Economic Co-operation and Development (OECD) countries, 2) reasons for this preference and 3) knowledge gaps and misperceptions about pregnancy and birth among young women that can inform educational strategies
Summary
Efforts to reduce unnecessary Cesarean sections (CS) in high and middle income countries have focused on changing hospital cultures and policies, care provider attitudes and behaviors, and increasing women’s knowledge about the benefits of vaginal birth. Many strategies have been tested to reduce the number of unnecessary cesarean sections These include active management of labor [8] continuous labor support [9], mode of delivery decision-aids and information for pregnant women [10, 11]
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