Abstract
BackgroundRates of caesarean section have steadily increased in most middle- and high-income countries over the last few decades without medical justification. Maternal request is one of the frequently cited non-medical factors contributing to this trend. The objectives of this study were to assess pregnant women’s preferences regarding mode of delivery and to compare actual caesarean section rates in the public and private sectors.MethodsA prospective cohort study was conducted in two public and three private hospitals in Buenos Aires, Argentina. 382 nulliparous pregnant women (183 from the private sector and 199 from the public sector) aged 18 to 35 years, with single pregnancies over 32 weeks of gestational age were enrolled during antenatal care visits between October 2010 and September 2011. We excluded women with pregnancies resulting from assisted fertility, women with known pre-existing major diseases or, with pregnancy complications, or with a medical indication of elective cesarean section. We used two different approaches to assess women’s preferences: a survey using a tailored questionnaire, and a discrete choice experiment.ResultsOnly 8 and 6 % of the healthy nulliparous women in the public and private sectors, respectively, expressed a preference for caesarean section. Fear of pain and safety were the most frequently expressed reasons for preferring caesarean section. When reasons for delivery mode were assessed by a discrete choice experiment, women placed the most emphasis on sex after childbirth. Of women who expressed their preference for vaginal delivery, 34 and 40 % ended their pregnancies by caesarean section in public and private hospitals, respectively.ConclusionsThe preference for caesarean section is low among healthy nulliparous women in Buenos Aires. The reasons why these women had a rate of more than 35 % caesarean sections are unlikely related to their preferences for mode of delivery.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-016-0824-0) contains supplementary material, which is available to authorized users.
Highlights
Rates of caesarean section have steadily increased in most middle- and high-income countries over the last few decades without medical justification
* Correspondence: amazzoni@iecs.org.ar 1Mother and Child’s Health Research Department, Institute for Clinical Effectiveness and Health Policy (IECS), Dr Emilio Ravignani 2024, C1414CPV Buenos Aires, Argentina Full list of author information is available at the end of the article recent systematic review and meta-analysis we found that only 16 % of women in a wide variety of countries expressed a preference for cesarean section (CS) [13]
The objectives of this study were to examine the preferences for mode of delivery for pregnant women delivering in public and private hospitals in Buenos Aires Province, Argentina, and to compare the CS rates for women who expressed a preference for vaginal delivery across public and private hospitals
Summary
Rates of caesarean section have steadily increased in most middle- and high-income countries over the last few decades without medical justification. The objectives of this study were to assess pregnant women’s preferences regarding mode of delivery and to compare actual caesarean section rates in the public and private sectors. Rates of cesarean section (CS) have steadily increased in most middle- and high-income countries over the last few decades without medical justification [1,2,3]. The different CS rates at public and private maternity hospitals suggest that either differences in patient preferences for mode. Our group has examined various motivational factors related to women’s preferences for mode of delivery among pregnant women attending public and private hospitals. Vaginal delivery was viewed as a normal, healthy, and a natural mode of delivery, except in the case of a medical indication for CS, which was viewed as a medical decision [15]
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