Preference For Cesarean Section Research Articles

Women's caesarean section preferences: A multicountry cross-sectional survey in low- and middle-income countries

ObjectiveTo measure the proportion of women's preferences for CS in hospitals with high caesarean section rates and to identify related factors. DesignA cross-sectional hospital-based postpartum survey was conducted. We used multilevel multivariate logistic regression and probit models to analyse the association between women's caesarean section preferences and maternal characteristics. Probit models take into account selection bias while excluding women who had no preference. SettingThirty-two hospitals in Argentina, Thailand, Vietnam and Burkina Faso were selected. ParticipantsA total of 1,979 post-partum women with no potential medical need for caesarean section were included among a representative sample of women who delivered at each of the participating facilities during the data collection period. FindingsThe overall caesarean section rate was 23.3 %. Among women who declared a preference in late pregnancy, 9 % preferred caesarean section, ranging from 1.8 % in Burkina Faso to 17.8 % in Thailand. Primiparous women were more likely to prefer a caesarean section than multiparous women (β=+0.16 [+0.01; +0.31]; p = 0.04). Among women who preferred caesarean section, doctors were frequently cited as the main influencers, and “avoid pain in labour” was the most common perceived benefit of caesarean section. Key conclusionsOur results suggest that a high proportion of women prefer vaginal birth and highlight that the preference for caesarean section is linked to women's fear of pain and the influence of doctors. These results can inform the development of interventions aimed at supporting women and their preferences, providing them with evidence-based information and changing doctors' behaviour in order to reduce the number of unnecessary caesarean sections. Clinical trial registryThe QUALI-DEC trial is registered on the Current Controlled Trials website (https://www.isrctn.com/) under the number ISRCTN67214403.

A cluster analysis of reasons behind fear of birth among women in Sweden.

Fear of birth is common and complex, caused by a variety of reasons. The aim was to investigate the prevalence of pre-established reasons in relation to fear, and to identify profiles of women based on their reported reasons behind fear of birth. A cross-sectional Swedish study of women with self-reported fear of birth who completed an online survey. Descriptive statistics, chi-square test, crude and adjusted odds ratios with 95% confidence intervals were used in the analysis of pre-established reasons in relation to self-reported severe fear. A Kappa-means cluster analysis was performed in order to group reasons, that were further investigated in relation to women's background variables. A total of 1419 women completed the survey. The strongest reason behind fear of birth was to be forced to give birth vaginally. Four clusters were identified and labeled: minor complexity (reference group), relative minor complexity, relative major complexity, and major complexity. Cesarean section preference, previous mental health problems, being younger, primiparity, and exposure to domestic violence were factors related to cluster grouping. Women with fear of birth have various reasons and diverse complexities behind their fear. Health care providers need to investigate these reasons and support pregnant women with childbirth fear, based on their needs.

How does hospital organisation influence the use of caesarean sections in low- and middle-income countries? A cross-sectional survey in Argentina, Burkina Faso, Thailand and Vietnam for the QUALI-DEC project

BackgroundImproving the understanding of non-clinical factors that lead to the increasing caesarean section (CS) rates in many low- and middle-income countries is currently necessary to meet the challenge of implementing effective interventions in hospitals to reverse the trend. The objective of this study was to study the influence of organizational factors on the CS use in Argentina, Vietnam, Thailand and Burkina Faso.MethodsA cross-sectional hospital-based postpartum survey was conducted in 32 hospitals (8 per country). We selected women with no potential medical need for CS among a random sample of women who delivered at each of the participating facilities during the data collection period. We used multilevel multivariable logistic regression to analyse the association between CS use and organizational factors, adjusted on women’s characteristics.ResultsA total of 2,092 low-risk women who had given birth in the participating hospitals were included. The overall CS rate was 24.1%, including 4.9% of pre-labour CS and 19.3% of intra-partum CS. Pre-labour CS was significantly associated with a 24-hour anaesthetist dedicated to the delivery ward (ORa = 3.70 [1.41; 9.72]) and with the possibility to have an individual room during labour and delivery (ORa = 0.28 [0.09; 0.87]). Intra-partum CS was significantly associated with a higher bed occupancy level (ORa = 1.45 [1.09; 1.93]): intrapartum CS rate would increase of 6.3% points if the average number of births per delivery bed per day increased by 10%.ConclusionOur results suggest that organisational norms and convenience associated with inadequate use of favourable resources, as well as the lack of privacy favouring women’s preference for CS, and the excessive workload of healthcare providers drive the CS overuse in these hospitals. It is also crucial to enhance human and physical resources in delivery rooms and the organisation of intrapartum care to improve the birth experience and the working environment for those providing care.Trial registrationThe QUALI-DEC trial is registered on the Current Controlled Trials website (https://www.isrctn.com/) under the number ISRCTN67214403.

Anxiety Disorders in Pregnant Women and its Effects on Choosing the Delivery Method

ObjectivesCesarean section is usually limited to cases where natural childbirth is not possible or is associated with serious risks to the fetus and mother. In the past few years, cesarean section has become a preferred method of delivery among women who are not medically indicated for the procedure. This study aimed to investigate the prevalence of anxiety in pregnant women and its relationship with choosing delivery methods and other demographic parameters. MethodsIn this study, 300 mothers referring to the hospitals of Shahid Beheshti University of Medical Sciences were selected by convenience sampling. The medical history of all patients was obtained, and the Beck questionnaire was used to determine the levels of anxiety. Results57% of mothers chose cesarean section as the method of delivery and the frequency of mild, moderate, and severe anxiety was estimated to be 36.33%, 19.33%, and 2.33%, respectively. It was seen that the preference for cesarean section was associated with higher levels of anxiety, higher education, older age, having a history of previous abortion, first pregnancy, and a gestation period of over 28 weeks. ConclusionsDue to the high prevalence of cesarean section in our country and its progress to higher percentages, it seems that the design and implementation of effective programs and interventions, including providing painless delivery, education, and psychological interventions.

Mode of delivery preferences: the role of childbirth fear among nulliparous women.

The increasing Cesarean Section (CS) rates may be attributed to women's increasing requests for elective CS. High Fear of Childbirth (FOC), especially among nulliparous women, may be significantly associated with CS preference without medical indications. The current study aims to investigate the impact of childbirth fear on the mode of delivery preference among nulliparous women. A cross-sectional correlational study was performed in the Maternal and Children Hospital (MCH) from the beginning of October 2022 to the end of February 2023 and incorporated a convenience sample of 342 nulliparous women. The data was collected using a self-reported questionnaire comprising participants' demographic and obstetrics characteristics and the FOC questionnaire. A logistic regression model examined the relationship between CS preference and the other independent variables. The results indicated that 74.3% of the nulliparous women preferred vaginal delivery, while 25.7% preferred Cesarean Section. Concerning childbirth-related fear, the highest mean scores were related to fear of clinical procedures, fear of harming or distressing the infant, and fear of pain 5.19 ± 1.13, 5.12 ± 1.27, and 5.09 ± 1.22, respectively. High FOC was present among 74.6%, moderate in 17.3%, and severe in 6.7% of the participants. Logistic regression analysis showed maternal age and monthly income were the significant sociodemographic determinants of choosing CS as the preferred delivery mode (p < 0.05). Moreover, the participants who had increased fear of harming or distressing the infant, fear from pain, fear from the body's ability to give birth, fear from not being involved in decision-making, and overall FOC had a higher probability of choosing CS as the preferred delivery mode compared to the participants who had lower fear (p < 0.05). Having high FOC increases the CS preference among nulliparous women. Increased fear of harming or distressing the infant, fear from pain, fear from the body's ability to give birth, and fear from not being involved in decision- making seem to be significant dimensions of childbirth fear associated with CS preference among nulliparous women.

“Because it eases my Childbirth Plan”: a qualitative study on factors contributing to preferences for caesarean section in Thailand

BackgroundAlthough caesarean section (CS) rates have increased rapidly in Thailand, the upward trend is not supported by significant maternal or perinatal health benefits. The appropriate use of CS through QUALIty DECision-making by women and providers (QUALI-DEC project) aims to design and implement a strategy to optimize the use of CS through non-clinical interventions. This study aimed to explore the factors influencing women’s and health professionals’ preferences for CS delivery in Thailand.MethodsWe conducted a formative qualitative study by using semi-structured in-depth interviews with pregnant and postpartum women, and healthcare staff. Purposive sampling was used to recruit participants from eight hospitals across four regions of Thailand. Content analysis was used to develop the main themes.ResultsThere were 78 participants, including 27 pregnant and 25 postpartum women, 8 administrators, 13 obstetricians, and 5 interns. We identified three main themes and seven sub-themes of women and healthcare providers’ perceptions on CS: (1) avoiding the negative experiences from vaginal birth (the pain of labor and childbirth, uncertainty during the labor period); (2) CS is a safer mode of birth (guarantees the baby’s safety, a protective shield for doctors); and (3) CS facilitates time management (baby’s destiny at an auspicious time, family’s management, manage my work/time).ConclusionsWomen mentioned negative experiences and beliefs about vaginal delivery, labor pain, and uncertain delivery outcomes as important factors influencing CS preferences. On the other hand, CS is safer for babies and facilitates multiple tasks in women’s lives. From health professionals’ perspectives, CS is the easier and safer method for patients and them. Interventions to reduce unnecessary CS, including QUALI-DEC, should be designed and implemented, taking into consideration the perceptions of both women and healthcare providers.

Driving Factors Influencing The Women's Preference and Decision-Making For Non-Medically Indicated Caesarean Section

Background:Caesarean section has become an emerging issue and catching attention worldwide. Shared decision-making among families and individuals has become a fashion and the main reason for women's preference for caesarean section. There are many societal factors that play an important role in unnecessary caesarean sections. Objective: To evaluate the driving factors influencing the women's preference and decision-making for caesarean section at the mother's request. Material and method: Qualitative research design used in this study via face-to-face in-depth interviews in a public-sector Faisalabad. IDI was conducted at the convenient time of the participant at the time of their antenatal visits. The interview's time was 30 to 40 minutes. The study's participants were pregnant women. A purposive sampling method was used. Data analysis was done on Nviovo software. Results: After transcribing the data, codes were made which leads to the basic themes with their sub-themes. The themes which were the influencing factors in women's preference and shared decision-making towards caesarean section were: child and maternal health, peer pressure (husband/mother-in-law/society influence), financial influence and hospital management (shortage of staff). Conclusion: The percentage of non-indicated caesarean sections has drastically increased day by day in the last ten years. There should be introduced some strategies for the education of women about pro cons and indications or non-indication for caesarean section.Patients' and peer preferences should be deliberated with healthcare practitioners. Healthcare staff should explain the indications of caesarean section at the time of antenatal.

Effectiveness of breathing exercise on the duration of labour: A systematic review and meta-analysis.

Prolonged labour intensifies labour pain, and failure to address labour pain may lead to abnormal labour and augments the usage of operative interventions. Prolonged labour is common among women, resulting in maternal morbidity, increased caesarean section (CS) rates, and postpartum complications. It may bring forth negative birth experiences that may increase the preference for CS. There is a dearth of evidence concerning the effectiveness of breathing exercises on the duration of labor. As per our knowledge, this is the first systematic review and meta-analysis on the effect of breathing exercises on the duration of labor. This systematic review and meta-analysis aimed to appraise the evidence concerning the effectiveness of breathing exercises on the duration of labour. Electronic databases MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, Web of Science, SCOPUS, and ClinicalKey were searched for randomized controlled trials, quasi-experimental studies published in the English language between January 2005 to March 2022 that reported on the effectiveness of breathing exercises on the duration of labour. Duration of labour was the primary analysed outcome. The secondary outcomes assessed were anxiety, duration of pain, APGAR scores, episiotomy, and mode of delivery. Meta-analysis was done using RevMan v5.3. The reviewed trials involved 1418 participants, and the study participants ranged from 70 to 320. The mean gestational weeks of the participants among the reported trials was 38.9 weeks. Breathing exercise shortened the duration of the intervention group's second stage of labour compared with the control group. Breathing exercise is a beneficial preventive intervention in shortening the duration of second stage of labour. The review protocol was registered with PROSPERO (CRD42021247126).

Factors Influencing Polish Women's Preference for the Mode of Delivery and Shared-Decision Making: Has Anything Changed over the Last Decade?

Background and Objectives: Shared-decision making has become an important trend in the problem of women's preference for the way of delivery. There are different factors influencing women, including obstetric history, culture, religion, family and social influences. Materials and Methods: The study was designed as an online survey with the aim of acquiring information about women's knowledge, opinions and preferences about the mode of delivery and the decision-making process. Data were collected from 1175 women in 2010 and 1033 in 2020. Results: A significant increase in the proportion of women who prefer vaginal delivery (VD) was found to be present with an increasing level of education, with the lowest rate in the group with primary education (66.0% in 2010 and 33.3% in 2020) and highest with medical education-86.3% in 2010 and 69.3% in 2020 (p &lt; 0.05). This trend existed both in 2010 and 2020; however, the proportion of women who preferred VD has decreased over the last decade in all groups, and even two-fold in the primary education group. No significant correlation was found between a history of previous delivery and the preference of the way of delivery, decision-making or paid cesarean delivery on maternal request (CDMR). A history of VD significantly reduced the preference for having a cesarean delivery, with only 6.9% of women in 2010 with a history of VD, and 8.9% in 2020 having preferred a cesarean delivery. In 2010, 34.9% of women with a history of cesarean section (CS) only, compared to 6.9% of women with a history VD only, had preference for CS with, respectively, 36.4% vs. 5.8% in 2020. Conclusions: As the proportion of women who prefer cesarean delivery has significantly increased over the last decade, we should emphasize the importance of educating women about the advantages and disadvantages of vaginal and cesarean delivery. The patient's preference should always be discussed with the obstetrician and the medical indications explained.

Preferred mode of childbirth among women attending antenatal clinic at a tertiary hospital in Ghana: a cross-sectional study.

The preference for mode of childbirth by women is emerging as a global subject of interest to many researchers, especially with the steady increase in caesarean section (CS) rates with some countries exceeding the world health organization (WHO) recommended rate. This study explored the preferences of mode of childbirth and associated factors among pregnant women in Ghana. A cross-sectional study was conducted among pregnant women at tertiary hospital in Ghana. Descriptive analysis and multivariate logistic regression were performed. Among the 415 pregnant women included, 357(86.0%) and 58(14.0%) preferred vaginal delivery and CS respectively. Majority (26%) attributed their preference for vaginal delivery to its being the natural way of childbirth. The most common reason why women preferred to deliver by CS was mainly influenced by medical indication such as doctors' remarks. Significant determinants influencing preference for CS were previous childbirth [aOR:0.21, 95%CI (0.05, 0.91)], previous caesarean [aOR:20.08, 95%CI (7.73, 52.19)] and urban settlement [aOR:2.51, 95%CI (1.01, 6.29)]. There was a clear preference for vaginal birth by pregnant women although a significant proportion preferred caesarean birth. Integration of women's preferred mode of childbirth into the clinical decision with appropriate counselling is recommended to improve women's pregnancy and childbirth experiences.

Association of Fear of Childbirth with the Preference for Cesarean Section; A Cross Sectional Study

Objective: To determine the fear of childbirth (FOC) amongst pregnant women and its association with preference for cesarean section.&#x0D; Study Design: Cross-sectional study.&#x0D; Place and Duration of Study: Department of Obstetrics and Gynecology Pak Emirates Military Hospital, Rawalpindi from Jan 2018 to Jun 2018.&#x0D; Methodology: Demographic and reproductive data of the patients including mode of delivery, was noted. The intensity of fear of childbirth was measured by Wijma delivery expectancy/experience questionnaire (W-DEQ), and a score was allotted. The total sum of scoring ranged from 0 to 165. A score of &gt;85-99 indicated an intense fear of childbirth, and ≥100 indicated very intense fear. The frequency of requests for cesarean section in women suffering from fear of childbirth was calculated.&#x0D; Results: A total of 335 patients were included. The mean age was 28.74 ± 3.58 years, and the mean gestational age was 39.50 ± 1.43 weeks. The mean W-DEQ score was 94.59 ± 9.86. The fear of childbirth calculated by W-DEQ in the third trimester of pregnancy showed no fear in 233 (69.55%) participants, intense fear in 42 (12.54%) and very intense fear in 60 (17.91%) women. The requests for cesarean section in women suffering from intense fear were made by 5 (11.90%) women and in women suffering from very intense fear of childbirth was 19 (31.67%) (p-value &lt;0.001).&#x0D; Conclusion: This study concluded that the intensity of fear of childbirth calculated by W-DEQ amongst pregnant women in the third trimester of pregnancy was relatively high, with a much higher rate ...

The Inconsistency Between Women's Preference and Actual Mode of Delivery in China: Findings From a Prospective Cohort Study.

BackgroundPrevious studies have found that the rates of cesarean preference were much lower than the actual rates of cesarean births in China. We aimed to observe this inconsistency between preferred and actual modes of delivery and the factors associated with the inconsistency.MethodsWe conducted a prospective cohort study at the maternity hospital with the largest number of deliveries in Beijing. We collected data through a questionnaire applied in the outpatient department, and medical records from the hospital's information system. Unconditional logistic regression was used to identify factors influencing the inconsistency between preferred and actual delivery mode.ResultsThe rates of actual cesarean section and of cesarean preference were 41 and 17%, respectively (χ2 = 82.9, P < 0.0001). The overall inconsistency rate was 31%, with 119 women preferred vaginal delivery but experienced cesarean section, accounting for 67% women undergoing cesarean section. Risk factors for this inconsistency between preferred vaginal delivery and actual cesarean section included: maternal obesity, receiving assisted reproduction, having an abnormal amniotic fluid volume, and fetal distress. Pre-labor rupture of membranes was a unique factor associated with such inconsistency between cesarean section preference and vaginal delivery at delivery.ConclusionsThe inconsistent rate between preferred delivery at late pregnancy and actual delivery is high in China. Further research is needed to understand how to lower cesarean rates in China, taking maternal preferences for vaginal deliveries into account.

Identifying factors associated with adolescents' Intention for childbirth.

Around the world, caesarean section rates have steadily increased over the past few decades. The World Health Organization (WHO) guidelines on nonclinical interventions to reduce caesarean section rates emphasize educational interventions and support programs. In this study, we have determined factors associated with adolescents' intention regarding childbirth options using the Theory of Planned Behavior (TPB). The sample was comprised of 480 high school students in Greece who were invited to complete a questionnaire consisting of three sections: a section on sociodemographic data; a section featuring the Adolescents' Intentions towards Birth Options (AIBO) scale, a recently developed instrument that accesses attitudes and intentions regarding vaginal birth and caesarean section; and a section detailing participants' awareness regarding reproduction and birth. Multiple logistic regression found that participants' impressions of vaginal birth and the TPB constructs were significantly associated with intention towards caesarean section. In particular, participants with a negative impression of vaginal birth had a 2.20-fold higher probability of reporting their preference for caesarean section, compared to participants with neither a negative nor a positive impression. Furthermore, participants with higher scores on the "Attitudes towards vaginal birth," "Subjective norms," and "Perceived behavior control over vaginal birth" subscales had a significantly lower probability of reporting preference for caesarean section. Our study demonstrates the effectiveness of the TPB to identify factors that influence adolescents' preference for childbirth. We highlight the necessity to implement nonclinical interventions to reduce the preference for caesarean section, providing evidence for developing school-based educational programs for a timely and consistency implementation.

Factors contributing to rising cesarean section rates in South Asian countries: A systematic review

Rising cesarean section (CS) rates are a global public health problem. The systematic review investigates key indications for performing CS and factors significantly associated with the rising rate of CS in South Asia. Primary studies in South Asia published between January 2010 and December 2018 were searched using relevant electronic databases: MEDLINE, Scopus, PubMed, Web of Science, CINAHL, NepJOL, and BanglaJOL. A narrative synthesis of the indications for performing CS and factors significantly associated with the rising CS rates was performed using content analysis. A total of 68 studies were included in this review. The most common medical indication for CS was fetal distress, followed by previous CS, antepartum hemorrhage (including placenta previa/abruption), cephalopelvic disproportion, failed induction, hypertensive disorders in pregnancy, oligohydramnios, and non-progress of labor. Maternal request was the most common non-medical indication for conducting CS. Higher maternal age was the most common significant factor associated with the rising CS rate followed by higher maternal education, urban residency, higher economic status, previous CS, pregnancy/childbirth complications, and lower parity/nulliparity. Preference for CS and increasing private number hospital were also factors contributing to the rising rate. Several key indicators and factors significantly associated with rising CS rate are revealed. These key indicators and significant factors reflect the global trend. Reduction in the use of primary CS, unless medically warranted, would help stem rates of CS. Realistic and candid explanation to pregnant women and their families regarding the benefits of vaginal birth for women and babies should form an integral part of maternity care as these are issues of public health.

Mode of delivery preferences among multiparous women based on previous birth experience

Aim: To explore associations between expectations regarding birth (including mode of delivery) and experience of the previous birth among multiparous women. Design: A cross-sectional study. Methods: A specially designed questionnaire was used to explore subjective perceptions of previous births. We also used the standardized questionnaire of birth-related fear (W-DEQ). Descriptive statistics and the ANOVA test, chi-square test, and Student t-test were used. The research group consisted of 111 pregnant women with a mean age of 31 (&#177; 3.58) years. Results: Most women preferred cesarean section as a mode of delivery (63.1%). Women who preferred cesarean section less frequently considered experiencing every stage of the birth to be an advantage of vaginal delivery. They more often perceived pelvic floor damage as a disadvantage of vaginal delivery (p = 0.000), and shorter delivery time as an advantage of cesarean section (p = 0.048). Significant fear of childbirth was confirmed in 25.2% of respondents. We found statistical significance between cesarean section preference and increased fear of childbirth (p = 0.05). Conclusion: Focusing on the impact of childbirth on the psychological state of a woman, should be one of the priorities of midwives to reduce fear of subsequent labor and prevent serious mental health issues.

An analysis of preferences and practices related to the mode of delivery in Agra district of Uttar Pradesh

Background: Preferences and actual practices in regard to delivery of pregnant women have wide variations. This study is an attempt to explore some of the socio-demographic factors responsible for preferences and practices in regard to mode of delivery among institutional deliveries in Agra district.Methods: This community based descriptive observational study was conducted among 300 eligible women of Agra district who were selected through multistage random sampling. Both bivariate and multivariate analysis was done and appropriate statistical tests were used.Results: The study found that out of 300 subjects; 272 had institutional deliveries among which 265 (97.43%) had a preference for vaginal delivery (VD) while only 7 (2.57%) had a preference for caesarean section (CS) but in actuality, 223 (81.99%) were delivered through vaginal mode while 49 (18.01%) had CS. On multiple logistic regression analysis, mode of delivery in previous pregnancy was found to have a significant association with the preference of a woman in regard to her mode of delivery with odds ratio of 9.88 (95% CI 1.46-66.80) and p=0.019.Conclusions: Preferences in regard to mode of delivery of a woman was only associated with her mode of delivery in previous pregnancy but her actual practice was also significantly associated with her place of delivery in addition to her mode of delivery in previous pregnancy.

Maternally requested caesarean delivery: Popularity amongst pregnant women at a South West Nigerian teaching hospital

Caesarean Section on maternal request is a planned surgery performed without medical indication, where the wish of the woman compensates for the lack of medical reasons. Preferences for caesarean section are often associated with some factors that may be cultural, economic, religious or social. Some women are said to suffer from tocophobia which is the fear of childbirth and may be a major psychological cause for caesarean section due to maternal request (CSMR). This study explored the popularity of maternally requested caesarean section amongst pregnant women in the Antenatal clinic of University of Medical Sciences Teaching Hospital, Akure. Method: It was a cross-sectional descriptive study. Results: Willingness to request for caesarean section if not indicated is found to be low with only about 10% indicating that they can do so. Rather, refusal to undergo caesarean section when medically indicated is found to be relatively high with 43 % of respondents indicating their unwillingness to have caesarean section even if indicated. Fear of adverse occurrence to mother or baby is the major reason for avoiding caesarean section Conclusion: Maternally requested caesarean section is not popular amongst pregnant women while aversion to indicated caesarean section is high in the study area. There is need for massive education and enlightenment on caesarean section in order to improve its acceptability.

Interventions for fear of childbirth including tocophobia.

Many women experience fear of childbirth (FOC). While fears about childbirth may be normal during pregnancy, some women experience high tosevereFOC. At the extreme end of the fear spectrum is tocophobia, which is considereda specific condition that may cause distress,affect well-being during pregnancy and impede the transition to parenthood.Various interventions have been trialled, which support women to reduce and manage high to severeFOC, including tocophobia. To investigate the effectiveness of non-pharmacological interventions for reducing fear of childbirth (FOC) compared with standard maternity care in pregnant women with high to severe FOC, including tocophobia. In July 2020, we searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP), and reference lists of retrieved studies. We contacted researchers of trials which were registered and appeared to be ongoing. We included randomised clinical trials which recruited pregnant women with high or severe FOC (as defined by the individual trial), for treatment intended to reduce FOC. Two review authors independently screened and selected titles and abstracts for inclusion. We excluded quasi-randomised and cross-over trials. We used standard methodological approaches as recommended by Cochrane. Two review authors independently extracted data and assessed the studies for risk of bias. A third review author checked the data analysis for accuracy. We used GRADE to assess the certainty of the evidence. The primary outcome was a reduction in FOC. Secondary outcomes were caesarean section, depression, birth preference for caesarean section or spontaneous vaginal delivery, and epidural use. We included seven trials with a total of 1357participants. The interventions included psychoeducation, cognitive behavioural therapy, group discussion, peer education and art therapy. We judged four studies as high or unclear risk of bias in terms of allocation concealment; we judged three studies as high risk in terms of incomplete outcome data; and in all studies, there was a high risk of bias due to lack of blinding. We downgraded thecertainty of the evidence due to concerns about risk of bias, imprecision and inconsistency. None of the studies reported data about women's anxiety. Participating in non-pharmacological interventions may reduce levels of fear of childbirth, as measured by the Wijma Delivery Expectancy Questionnaire (W-DEQ), but the reduction may not be clinically meaningful (mean difference (MD) -7.08, 95% confidence interval (CI) -12.19 to -1.97; 7 studies, 828 women; low-certainty evidence). The W-DEQ tool is scored from 0 to 165 (higher score = greater fear). Non-pharmacological interventions probably reduce the number of women having a caesarean section(RR 0.70, 95% CI 0.55 to0.89; 5 studies, 557 women; moderate-certainty evidence). There may be little to no difference between non-pharmacological interventions and usual care in depression scores measured with the Edinburgh Postnatal Depression Scale (EPDS) (MD 0.09, 95% CI -1.23to 1.40;2 studies, 399 women;low-certainty evidence). The EPDS tool is scored from 0 to 30 (higher score = greater depression). Non-pharmacological interventions probably leadto fewer women preferring a caesarean section (RR0.37, 95% CI 0.15 to 0.89; 3 studies, 276 women; moderate-certainty evidence). Non-pharmacological interventions may increase epidural use compared with usual care, but the 95% CI includes the possibility of a slight reduction in epidural use (RR 1.21, 95% CI 0.98 to 1.48;2 studies, 380 women; low-certainty evidence). The effect of non-pharmacological interventionsfor women with high to severe fear of childbirth in terms of reducing fear is uncertain.Fear of childbirth, as measured by W-DEQ, may be reduced but it is not certain if this represents a meaningful clinical reduction of fear. There may be little or no difference in depression, but there may be a reduction in caesarean section delivery. Future trials should recruit adequate numbers of women and measure birth satisfaction and anxiety.

Knowledge and Preference Towards Mode of Delivery among Pregnant Women in the United Arab Emirates: The Mutaba'ah Study.

Background: The rate of cesarean section (CS) is growing in the United Arab Emirates (UAE). Pregnant women’s knowledge on the mode of delivery, factors associated with lack of adequate knowledge, and preference towards CS delivery were investigated. Methods: Baseline cross-sectional data from 1617 pregnant women who participated in the Mutaba’ah Study between September 2018 and March 2020 were analyzed. A self-administered questionnaire inquiring about demographic and maternal characteristics, ten knowledge-based statements about mode of delivery, and one question about preference towards mode of delivery was used. Knowledge on the mode of delivery was categorized into “adequate (total score 6–10)” or “lack of adequate (total score 0–5)” knowledge. Crude and multivariable models were used to identify factors associated with “lack of adequate” knowledge on the mode of delivery and factors associated with CS preference. Results: A total of 1303 (80.6%) pregnant women (mean age 30.6 ± 5.8 years) completed the questionnaire. The majority (57.1%) were ≥30 years old, in their third trimester (54.5%), and had at least one child (76.6%). In total, 20.8% underwent CS delivery in the previous pregnancy, and 9.4% preferred CS delivery for the current pregnancy. A total of 78.4% of pregnant women lacked adequate knowledge on the mode of delivery. The level of those who lacked adequate knowledge was similar across women in different pregnancy trimesters. Young women (18–24 years) (adjusted odds ratios (aOR), 3.07, 95% confidence interval (CI), 1.07–8.86) and women who had CS delivery in the previous pregnancy (aOR, 1.90, 95% CI, 1.06–3.40) were more likely to be classified with a lack of adequate knowledge. Age (aOR, 1.08, 95% CI, 1.02–1.14), employment (aOR, 1.96, 95% CI, 1.13–3.40), or previous CS delivery (aOR, 31.10, 95% CI, 17.71–55.73) were associated with a preference towards CS delivery. Conclusion: This study showed that pregnant women may not fully appreciate the health risks associated with different modes of delivery. Therefore, antenatal care appointments should include a balanced discussion on the potential benefits and harms associated with different delivery modes.

'A caesarean section is like you've never delivered a baby': A mixed methods study of the experience of childbirth among French women.

The experience of childbirth has been technologized worldwide, leading to major social changes. In France, childbirth occurs almost exclusively in hospitals. Few studies have been published on the opinions of French women regarding obstetric technology and, in particular, caesarean section. In 2017–2018, we used a mixed methods approach to determine French women’s preferences regarding the mode of delivery, and captured their experiences and satisfaction in relation to childbirth in two maternity settings. Of 284 pregnant women, 277 (97.5%) expressed a preference for vaginal birth, while seven (2.5%) women expressed a preference for caesarean section. Vaginal birth was also preferred among 26 women who underwent an in-depth interview. Vaginal birth was perceived as more natural, less risky and less painful, and to favour mother–child bonding. This vision was shared by caregivers. The women who expressed a preference for vaginal birth tended to remain sexually active late in their pregnancy, to find sexual intercourse pleasurable, and to believe that vaginal birth would not enlarge their vagina. A large majority (94.5%) of women who gave birth vaginally were satisfied with their childbirth experience, compared with 24.3% of those who underwent caesarean section. The caring attitude of the caregivers contributed to increasing this satisfaction. The notion of women’s ‘empowerment’ emerged spontaneously in women’s discourse in this research: women who gave birth vaginally felt satisfied and empowered. The vision shared by caregivers and women that vaginal birth is a natural process contributes to the stability of caesarean section rates in France.