Stress perceived by pregnant and decision-making factors of maternal caesarean section request

Abstract

Abstract Background Pregnancy is a time of psychological vulnerability which can generate intense stress. This represents a maternal and child public health problem. Prenatal stress has harmful impacts on the foetus, the newborn and can cause an increased maternal request for caesareans sections, with nonmedical grounds. The perceived level of prenatal stress factors was assessed in women, as well as mothers’ incentives and decision-making factors for a caesarean section on maternal request. Methods A descriptive study on 203 pregnant women, then a comparative study between primiparas (n = 72) and multiparas (n = 131) were carried out with the Antenatal perceived stress inventory. Incentives and decision-making factors for a caesarean on the mother’s demand were studied by in-depth interviews with primiparas mothers (n = 16) who had made this choice. Results The perception of stress level during pregnancy is higher at the first quarter regarding the foetus’ health, medical and obstetric risks and reverses with the perception of projections linked to giving birth at the last quarter. Primiparas are significantly (p < 0.001) more stressed. All the elements of the three assessed factors are very significantly (p < 0.001) correlated for the whole population. Among them, 75% choose a caesarean section on maternal request during the first quarter. This choice is confirmed at the end of the second quarter or during the third one for 50% of them, with a one-month time to think for 58.3% of them. The main incentives are tokophobia (66.7%) and preserving the baby’s health (50%). Conclusions Pregnancy causes important stress, which is pronounced in primiparas. In France, these results speak in favour of screening tokophobia and an earlier start of birth and parenthood preparation classes in order to handle stress from the first quarter of pregnancy, when medical and prenatal exams are initiated. Birth preparation should be taken on at the last quarter. Key messages Investigate stress perceived and identification incentives and decision-making factors of maternal caesarean section request it’s a solution to building bridge for solidarity with tokophobic women. The relation enter stress perceived by pregnant women and decision-making factors of maternal caesarean section request, represents a maternal and child public health problem.