Choice Of Delivery Mode Research Articles

Impact of planned delivery mode on neonatal outcomes and costs in twin pregnancies in Kenya

BackgroundTwin pregnancies are associated with higher risks of adverse neonatal outcomes compared to singleton pregnancies. The choice of delivery mode, when twin A presents cephalic, remains a subject of debate. In low- and middle-income countries, where healthcare resources are limited, the decision on the mode of delivery is even more critical. ObjectiveTo evaluate the neonatal outcomes and the hospital costs of planned vaginal delivery compared to cesarean section (CS) in twin pregnancies with twin A presenting cephalic at Tenwek Hospital, Kenya. Study DesignThis retrospective cohort study analyzed data from all twin deliveries at Tenwek Hospital, Kenya from, April 1, 2017, to March 30, 2023. Maternal data, mode of delivery, and neonatal data were collected from delivery logs, electronic health records, and neonatal records. Neonatal outcomes were a composite of either Appearance, Pulse, Grimace, Activity, and Respiration score less than seven at 5 minutes, neonatal intensive care unit admission, resuscitation, birth trauma, or neonatal complications, including death before discharge from the hospital. A logistic regression model was created to assess the impact of the planned mode of delivery on neonatal outcomes, controlling for antenatal care clinic visits, noncephalic presentation of twin B, and birth weight category. ResultsThe study included 177 twin deliveries: 129 (72.9%) were planned as vaginal deliveries and 48 (27.1%) were planned for CS. Among the planned vaginal deliveries, 66 (51.2%) experienced adverse outcomes, compared to 14 (29.2%) in the CS group (P=.009). Logistic regression showed that the odds of adverse outcomes were 0.35 times lower in the CS group compared to the planned vaginal delivery group (95% CI: 0.15–0.83; P=.017). The average total hospital costs for planned vaginal delivery were 104,608 Kenya Shillings (standard deviation 111,761) compared to 100,708 Kenya Shillings (standard deviation 75,468) for CS (P=.82). ConclusionPlanned cesarean deliveries in twin pregnancies with twin A presenting cephalic at Tenwek Hospital were associated with fewer adverse neonatal outcomes compared to planned vaginal deliveries. There was no significant difference in hospital costs. These findings raise the question of the safest mode of delivery for patients in a resource-constrained setting.

Obesity at term: What to consider? How to deliver?

Obesity presents significant challenges during pregnancy, increasing the risk of complications and adverse outcomes for both mother and baby. With the rising prevalence of obesity among pregnant women, questions arise regarding optimal management, including timing of delivery and choice of delivery mode. Labour induction in obese women may require a combination of mechanical and pharmacological methods due to increased risk of failed induction. Caesarean section in obese women presents unique challenges, requiring comprehensive perioperative planning and specialized care to optimize outcomes. However, specific guidelines tailored to obese patients undergoing caesarean sections are lacking. Postpartum care should include vigilant monitoring for complications. Addressing obesity in pregnancy necessitates a multidisciplinary approach and specialized care to ensure the best outcomes.

The Effect of "Motivational Interviewing" and "Information, Motivation, and Behavioral Skills Model" Counseling Interventions on the Choice of Delivery Mode in Pregnant Women Using Face-to-Face Training vs. Mobile App: A Randomized Controlled Trial.

To investigate the impact of counseling interventions, using face-to-face training vs. mobile app for choosing mode of delivery. A four-armed, randomized, controlled parallel-design trial. Setting. Ebnesina Private Hospital in Tehran, Iran. Population. Pregnant women, between 24 and 32 weeks of gestation (n = 120). Pregnant women were randomly assigned in three psycho-educational intervention groups: (1) motivational interviewing via face-to-face training, (2) information, motivation, and behavioral skills model via face-to-face training, (3) the same model via a mobile application, and (4) usual antenatal care (control group). To assess the face-to-face and mobile app training method on women's self-efficacy and intention in choosing a mode of delivery. Main Outcome Measures. Mode of delivery (Cesarean section). While all three intervention groups showed significant increases in women's self-efficacy and intentions to choose vaginal delivery, the increase was particularly noticeable among those using mobile applications: Before the intervention, self-efficacy and intention Mean ± SD were 77.1 ± 38.6 (CI-95%: [62.72, 91.60]) and 1.10 ± 0.305 (CI-95%: [0.99, 1.21]), respectively. After the intervention, these scores increased to 99.7 ± 30.7 (CI-95%: [88.27, 111.20]) for self-efficacy and 1.70 ± 0.466 (CI-95%: [1.53, 1.87]) for intention. Although 56.7% of women in the intervention groups expressed a preference for vaginal delivery, only 37.5% ultimately pursued this birthing method. Brief psycho-educational interventions, particularly technology-driven interventions (mobile apps) can increase the likelihood of women choosing vaginal delivery. To enhance the effectiveness of such interventions, they can be conducted in conjunction with interventions for doctors and healthcare providers. This trial is registered with IRCT20151208025431N7.

Towards more sustainable online consumption: The impact of default and informational nudging on consumers’ choice of delivery mode

The increasing CO2 emissions from e-commerce deliveries present a pressing environmental concern. If half of all consumers decided to have their online order delivered to a pick-up point instead of at home, this could vastly reduce CO2 emissions of e-commerce. This study investigated (a) whether nudging could help consumers shift towards pick-up point delivery as a more sustainable choice, and (b) which type of nudging would be most effective. An RCT was conducted with a representative sample of the Dutch population (N = 1213). In an online store setting, participants selected a product and completed the check-out process – selecting between more and less sustainable delivery options. Their selection had real consequences as the gift would be delivered with the selected delivery method. Four different nudging conditions were contrasted: a default nudge, in which the most sustainable option (i.e., delivery to pick-up point) was selected automatically, and three decision-information nudges, in which CO2 emissions for the delivery options was displayed. The decision-information nudges varied in complexity, from high complexity (emissions in grams of CO2 for each delivery option) to medium (percentage of CO2 reduction for the most sustainable option) and low complexity (a green leaf next to the most sustainable option). Relative to control, the default nudge was the most effective at steering participants towards the most sustainable delivery choice, followed by the medium- and low-informational nudging conditions. In addition, instead of steering them towards the most sustainable delivery option, the high-informational nudge appeared to steer participants away from the two most polluting delivery options – thereby potentially saving more greenhouse gas emissions (GHG) than the other conditions. In sum, this study provides substantial evidence for the use of behavioral strategies in quest towards more sustainable online consumption.

Preferences of pregnant individuals to undergo labor after one cesarean in southern China.

Labor after cesarean (LAC) remains an optional delivery method among healthy pregnant individuals. Exploring women's attitudes, preferences, reasons for previous cesarean delivery, and the incentives underlying pregnant individuals' preferences could help us understand their choice of delivery mode. In this study we evaluated the preferences and attitudes of eligible pregnant women regarding participation in a LAC in Foshan, China. A cross-sectional survey was conducted among 438 pregnant individuals with one prior cesarean delivery (CD) who attended their antenatal examination at a tertiary hospital in southern China, between November 1, 2018, and October 31, 2019. Information on demographic characteristics, obstetric data, preferences for LAC, and incentives for LAC were analyzed. Overall, 85.4% (374/438) of women preferred LAC if they did not have contraindications before delivery, whereas 12.3% (54/438) refused and 2.3% (10/438) were unsure. Participants reported that the most important factors affecting their willingness to undergo LAC were safety indicators (i.e., "ability of hospitals to perform emergency cesarean delivery" [score of 9.28 ± 1.86]), followed by accessibility indicators (i.e., "priority bed arrangements" [score of 9.17 ± 1.84]). Logistic regression analysis indicated that neonatal wellbeing with the prior CD was an independent influencing factor (OR = 2.235 [95%CI: 1.115-4.845], p = 0.024) affecting willingness to access LAC in the subsequent pregnancy. We found a high preference for LAC among pregnant individuals without contraindications before delivery in southern China. Healthcare providers need to ensure access to LAC and increase pregnant individuals' LAC willingness through high-quality shared decsision-making in alignment with patient preferences.

Chronic kidney disease and pregnancy: an interdisciplinary assessment of gestational risks and complications. A literature review

Chronic kidney disease represents a heterogeneous group of diseases characterized by changes in the kidneys structure and functions. It significantly increases the risks of adverse maternal and perinatal outcomes. These risks increase with worsening renal dysfunction corresponding to an increase in the degree of proteinuria and arterial hypertension. Anatomical and physiological changes in the kidneys during pregnancy are characterized by dilatation of the pelvicalyceal system, a decrease in systemic and renal vascular resistance, and an increase in the glomerular filtration rate. These clinically significant changes can complicate the diagnosis of the renal dysfunction, as well as its progression. Pregnancy can affect the kidney as it can manifest as declining kidney function, especially in the context of concomitant arterial hypertension and proteinuria, while chronic kidney disease, regardless of the stage, contributes to a higher risk of adverse pregnancy outcomes including preeclampsia, premature birth and fetal growth restriction.
 Optimization strategies of pregnancy outcomes include strict control of blood pressure, treatment of hypertension and proteinuria, and prevention of preeclampsia. The latter is difficult to diagnose in pregnant women with chronic kidney disease. Serum markers such as soluble fms-like tyrosine kinase 1 and placental growth factor may aid in definitive diagnosis. The choice of delivery mode in women with chronic kidney disease should be based on common obstetric indications. A multidisciplinary team, including an obstetrician-gynecologist, a nephrologist, an anaesthesiologist and a neonatologist, must focus on preconception medical care, antenatal care and treatment of pregnant women with chronic kidney disease for a successful pregnancy outcome.

Influence of Social Media on Pregnant Women’s Stress, Attitude and Fear toward Choice of Delivery Mode

Influence of Social Media on Pregnant Women’s Stress, Attitude and Fear toward Choice of Delivery Mode

Considering modes of delivery in blended PBL: a literature-based approach

The COVID-19 pandemic had accelerated Blended Learning in many institutions worldwide, catapulting it into a now permanent spot in the school curriculum in many higher learning institutions. However, given the infinite permutations in blended learning, it is not surprising that it has led to contradictory student outcomes and learning experiences. Research has suggested the combination of Problem-based learning and blended learning can lead to constructivist learning environments that promote 21st century skills such as innovative uses of technology, problem-solving and collaborative skills. However, there is little to guide educators in the design of blended PBL. One design consideration is the choice of delivery modes. In this presentation, the literature is explored for the essential instructional components in PBL, and the modes of delivery that best support them. This could be offered as a starting point to support lesson designers approaching blended PBL.

Changes made to the teaching of linear algebra and calculus courses in the UK in response to the COVID-19 pandemic

In response to the COVID-19 pandemic, university mathematics departments in the UK adapted their teaching for 2020-21, with some courses being delivered digitally and others through a mixture of on-campus and digital delivery. A survey of linear algebra and calculus lecturers was carried out in the spring of 2021 to investigate what changes were made to courses, as well as lecturers’ perceptions of institutional decision making and support. This survey found that a majority of the 41 participants were satisfied that the choice of delivery mode was correct, although views about the importance of offering on-campus classes were mixed. There was a significant increase in the use of video clips made by the lecturer, video-conferencing software, discussion forums, electronic submission of written work and on-screen marking tools. Most lecturers reported a reduction in the amount of time that students were expected to be taking part in live teaching activities and an increase in the amount of time they were expected to be working on asynchronous activities. While some were keen to return to their previous practice, others were enthusiastic about retaining features introduced in response to the COVID-19 pandemic.

Acceptability of telehealth-delivered rehabilitation: Experiences and perspectives of people with traumatic brain injury and their carers

Introduction Communication skills training for people with traumatic brain injury (TBI) and their carers is recommended best practice. Delivery via telehealth could improve access to this training. This paper focuses on the acceptability of telehealth delivery of communication skills training. Methods A mixed-methods investigation of acceptability of telehealth to people with TBI and their carers was incorporated into a clinical trial. Thirty-six people with TBI (23 metropolitan and 13 regional) and their carers were recruited. Metropolitan participants were randomly allocated to telehealth or in-person intervention at a 1:3 ratio. Regional participants were allocated to telehealth. Telehealth and in-person participants were compared on retention, time to complete the programme, home practice completion and therapeutic alliance ratings. Participants completed semi-structured interviews regarding their views on telehealth, which were analysed using thematic analysis. Results There were no significant differences between telehealth and in-person participants in retention rate, time to complete the programme, degree of home practice completion or therapeutic alliance ratings. Three themes were identified: ‘telehealth delivery opens a window for access to rehabilitation in the context of my daily life’, ‘in-person delivery offers rehabilitation based on natural human interaction’ and ‘weighing telehealth against in-person delivery’. Discussion Participants found telehealth delivery acceptable, as indicated by the similarity between groups in the quantitative process measures, and as reported in interviews. Some reported a preference for in-person delivery if there had been a choice of delivery mode. Participants described characteristics of the two delivery modes which were relevant to their attitudes towards telehealth.

The Effect of Peer Education on Pregnant Women's Choosing Mode of Delivery

Background & aim: Women's choice on the type of delivery mode is an important event in every pregnant women’s lifetime. Proper education is one of the most important factors that can help women to choose the delivery type. In this regard, one of the educational methods is peer education. Therefore, this study aimed to determine the effect of peer education on the choice of delivery mode. Methods: This quasi-experimental study was conducted on 160 primiparous women at 34-36 week of gestation without indications of cesarean section section. The participants were selected from the health centers in Mashhad, Iran, during 2017 and randomly assigned into two groups of peer education and control group. In total, 10 participants were selected as peers and trained by a researcher. Then the peers were asked to train participants in eight-person groups, and the control group received routine care. A self-structured questionnaire was used to collect data in relation to mode of delivery. Moreover, the data were analyzed in SPSS software (version 19) using the independent t-test and Chi-square test. Results: There were no differences between the groups regarding the intention to choose the delivery methods before the intervention (P=0.73). However, the obtained results revealed higher levels of intention to choose vaginal delivery in the intervention group, compared to that in the control group (p <0.001). Conclusion: The participants who were subjected to peer education acquired higher levels of intention to choose vaginal delivery.

Public Private Partnerships Review of Kazakhstan

Kazakhstan has put in place a well-structured legal and institutional framework for preparing Public Private Partnerships (PPPs) at both the national and regional levels. The government has prioritised PPPs as a delivery mode for both economic and social infrastructure. The central emphasis on PPPs had a strong impact at the regional level with a large number of relatively small projects signed in the past years. At the national level the impact has been modest mostly due to financing challenges. In terms of priority areas for reform, the report outlines capacity building (particularly during the project preparation phase), the need to promote quality over quantity of PPPs, strengthening the methods used to guide the choice of delivery mode, and transparency and accounting of contingent liabilities

Effect of progressive muscle relaxation training on the psychological status, compliance and delivery outcomes of primiparas

Objective To explore the effect of progressive muscle relaxation training on the psychological status, compliance and delivery outcomes of primipara. Methods From January 2016 to December 2017, 224 primiparas who delivered at Taizhou Municipal Hospital were divided into control group and observation group according to the random number table method, with 112 cases in each group. The control group was given routine treatment, and the observation group was given gradual muscle relaxation training based on the control group. The depression and anxiety scores before and after treatment in the two groups were evaluated. The compliance of mothers to the doctors' choice of delivery methods was investigated, and the delivery outcomes and postpartum recovery status were analyzed. Results The scores of depression and anxiety in the observation group were significantly lower than those in the control group(all P<0.05). The compliance with the doctors' choice of delivery mode in the observation group was 95.53%(107/112), which was significantly higher than that in the control group[87.50%(98/112)](χ2=4.658, P=0.030). The normal delivery rate of the observation group was 91.07%(102/112), which was significantly higher than that of the control group[80.35%(90/112)](χ2=5.250, P=0.021). The total labor of spontaneous delivery in the observation group was significantly shorter than that in the control group, the bleeding volume at 2 hours after delivery in the observation group was obviously less than that in the control group, the postpartum hospital stay in the observation group was significantly shorter than that in the control group, the differences were statistically significant(all P<0.05). The scores of postpartum maternal pain, libido, vaginal resistance, and vaginal lubrication in the observation group were significantly lower than those in the control group(all P<0.05). Conclusion Application of progressive muscle relaxation training in primiparas can reduce the negative emotions, better coordinate with medical personnel, enhance rational choice, better improve pregnancy outcome, promote postpartum recovery, and improve postpartum sexual life quality. Key words: Maternal health services; Progressive muscle relaxation training; Depression; Anxiety; Pregnancy outcome; Compliance; Quality of life

A survey of ophthalmologists and gynecologists regarding termination of pregnancy and choice of delivery mode in the presence of eye diseases

PurposeTo evaluate and compare the attitudes of ophthalmologists and gynecologists in suggesting appropriate approach to pregnancy in different ocular conditions. MethodsSpecialty-specific questionnaires on delivery mode and abortion indications for ophthalmic patients (refractive, vascular, oncologic, retinal, glaucoma, postoperation, posttrauma, and infectious) were designed and distributed among physician staff of Farabi Eye Hospital and Yas Women Hospital in Tehran. Attitudes and preferences of the ophthalmologists and gynecologists were quantified and compared. ResultsParticipants were 29 ophthalmologists and 19 gynecologists. Their mean age was 49.73 ± 7.57 and 46.79 ± 1.36 years, respectively. More than 50–70% ophthalmologists were in favor of normal vaginal delivery (NVD) in all ocular diseases. All gynecologists (100%) expressed their need for an ophthalmologist's opinion for decision-making. Ophthalmologists' top choices for conditions potentially requiring a caesarean section were corneal transplants (34.5%), high myopia (23%), retinal detachment (29%), and orbital tumors (34.5%), while two gynecologists recommended abortion in the presence of intraocular and orbital tumors and retinal detachment.In the case of a history of refractive surgery, orbital tumor and intraocular tumor, ophthalmologists recommend NVD over caesarean section twice as much as their gynecologist peers. For history of retinal detachment, glaucoma, retinal vascular accident and intraocular hemorrhage, no single gynecologist recommend NVD. The corresponding figure for ophthalmologist-recommended NVD were 67, 84, 72, and 81%. ConclusionsThere is extreme inconsistency among ophthalmologists and gynecologists in managing ophthalmic-obstetric scenarios, especially for caesarean section indications. Clinical guideline development and consultation for decision-making in challenging cases are recommended.

Preference of Birth Delivery Modes among Women Attending Antenatal and Postnatal Clinics in the Tamale Metropolis of Ghana

Introduction: Spontaneous vaginal delivery is the commonest mode of delivery globally, particularly in remote areas of resource constrained countries where modern healthcare is limited. This study sought to establish among antennal and post natal attendees, women’s preferences regarding modes of delivery and the factors influencing their choices of delivery. Methods: This cross sectional hospital based study was conducted at the antenatal and post-natal care units of the obstetrics and gynaecology department of the Tamale Teaching Hospital. Data on respondents’ demographic characteristics, their preferred mode of birth delivery, and the reasons influencing their choice of delivery modes were collected via a structured closed and opened ended questionnaire. Results: A total of 499 women were interviewed. Majority (86.6%), of the respondents were within the ages of 18 to 34 years with modal age of 30 years and a mean age of 27.9 ± 5.6 years. In all, 85.0% (424) and 12.0% (60) preferred spontaneous vaginal delivery (SVD) and SVD with epidural anaesthesia respectively, while 3.0% (15) preferred delivery by elective caesarean section (CS). Majority (97.2%) of the respondents took self-decisions on their preferred mode of delivery. However, those who were influenced by healthcare workers were 1%, while 0.4% was influenced by their husbands and other family members respectively. Conclusion: In conclusion, the study revealed that the respondents most preferred choice of mode of delivery was SVD, followed by SVD with epidural anaesthesia, with caesarean section being the least preferred. The respondents’ have relatively low external influence regarding their preferred choice of delivery.

Individualized management of pregnant women with high hepatitis B virus DNA levels

Hepatitis B is a major health concern in the Asia-Pacific region, and is endemic in China, Southeast Asia, and Africa. Chronic hepatitis B virus (HBV) infection may cause hepatic cirrhosis and liver cancer. It is estimated that there are more than 350 million chronic HBV carriers worldwide, of whom approximately one quarter will die of chronic hepatitis B-related liver diseases. HBV is transmitted horizontally through blood and blood products or by sexual transmission, and vertically from mother to infant. Perinatal infection is the predominant mode of transmission in countries with a high prevalence of hepatitis B surface antigen (HBsAg) carriage, and perinatal transmission leads to high rates of chronic infection. Therefore, it is important to prevent the mother-to-child transmission (MTCT) of HBV. Research has shown that pregnant women with high HBV DNA levels have an increased risk of MTCT. However, most of the obstetrics guidelines do not make a distinction between pregnant women with high HBV DNA levels and those who are HBsAg positive only. This review addresses the management of pregnant women with high levels of HBV viremia, in terms of antiviral therapy, use of hepatitis B immunoglobulin (HBIG), the combined application of hepatitis B vaccine and HBIG, choice of delivery mode and feeding practices.

Breech delivery – what influences on the mother's choice?

To investigate factors influencing the mother's choice of delivery mode when vaginal breech delivery is considered possible and safe. Retrospective study. University Hospital. Singleton, term pregnancies with breech presentation were included, n = 390. Information was collected from patient records from January 2006 to December 2010. A questionnaire was sent to those 293 women in whom vaginal breech delivery was considered possible and safe. Patient characteristics by choice of delivery mode. Women who were selected for vaginal breech delivery (n = 187) were younger, more often nulliparous and gave birth to smaller babies. Women who requested a cesarean section (n = 112) became more worried when the breech presentation was diagnosed. They had a more negative initial view on breech presentation, more often took additional advice from nonprofessionals and trusted them more. Women who requested cesarean section reported a positive birth experience more frequently than women who were selected for vaginal delivery, whether ending as vaginal or emergency cesarean delivery. Women in both groups searched web-based information about breech delivery. We found no differences between the sources of information used. Younger, nulliparous women with smaller babies trusted and listened more to professional advice and were more prone to choose vaginal delivery. Women who requested a cesarean section were more worried and had a more negative initial view on breech presentation. Both groups sought web-based information equally.

Development of ODL in a newly industrialised country according to face-to-face contact, ICT, and e-readiness

&lt;p&gt;A large number of unqualified and under-qualified in-service teachers are holding back socio-economical development in South Africa, a newly industrialized country. Open and distance learning (ODL) provides an innovative strategy and praxis for developing and newly industrialized countries to reach their educational and socio-economical objectives through professional development and training. In order to examine factors which affect the success of ODL offered by the North-West University in South Africa, a qualitative and quantitative research approach is used. Factors examined include face-to-face classroom contact, the implementation and use of ICTs, and e-readiness. The relationships between these factors are also discussed. A questionnaire was administered to 87 teacher-students in four Advanced Certificate in Education (ACE) programs to collect quantitative data regarding aspects of their classes and the e-readiness of students. This data was qualitatively elaborated upon by three semi-structured, open-ended focus-group interviews. Besides descriptive statistics, Spearman’s rank-order correlations (&lt;em&gt;r&lt;/em&gt;) were determined between variables pertaining to negative feelings towards face-to-face classroom contact, ODL as students’ choice of delivery mode, and students’ positive attitude towards information and communication technology (ICT). Combined quantitative and qualitative findings were used to evaluate the effectiveness of contact classes as well as the e-readiness of students towards the attainment of ODL development Phase D. This phase refers to UNESCO’s description of ICT implementation, integration, and use. Relationships (Spearman’s rank-order correlations) between ODL, as teacher-students’ choice of educational delivery mode, and aspects of their e-readiness suggest that the e-readiness of teacher-students is implicit to their choice of ODL as educational delivery mode for professional development.&lt;/p&gt;

The perceptions of women about the choice of delivery modes: a descriptive study

Objetivo:Discutir a percepcao das mulheres quanto a escolha da via de parto. Metodologia: Estudo qualitativo realizado em hospital de ensino e uma unidade basica de saude do Rio Grande do Sul, de janeiro a marco de 2011. Foram entrevistadas oito mulheres fora do periodo gravidico puerperal, e em idade fertil. Os dados foram analisados e interpretados conforme analise de conteudo tematica. Resultados e Discussao: Emergiu a categoria A percepcao das mulheres na decisao sobre o tipo de parto, na qual foi significativo o entendimento das mulheres sobre o poder de decisao que os medicos tem em relacao ao tipo de parto. Porem, algumas discordam dessa postura e apontam para a vontade da sua inclusao nessa decisao. Conclusao: Algumas mulheres discordam do poder unilateral do medico sobre o parto, defendendo que a decisao deveria ser compartilhada com elas, uma vez que sao estas que sentem e passam pelo processo.

Influencing factors of delivery modes for pregnant women at a local community of Shanghai

Objective To investigate the selection of dilivery of pregnant women and related factors.Methods The selection of delivery modes for pregnant women was investigated by analyzing the associated factors of the infants registered into a computerized health care managing system from January 1,2008 to December 31,2010 at a local community of Shanghai.The information associated with delivery modes of their mothers was collected and the choice of delivery modes investigated through a standardized questionnaire by interviewing the mothers at two months after birth.Results The cesarean section (C/S)rate of pregnant women residing in this local area was 58.3 ％ (224/384).In the C/S group,the percentages of delivery age ≥24 yr,white-collar workers,education level at high school and above and monthly income ≥ 3000 yuan were 73.2％ ( 164/224 ),38.4％ ( 86/224 ),79.5％ ( 178/224 ) and 80.8％ ( 181/224 )respectively.And they were all higher than those of vaginal delivery (63.1％,n =101; 32.5％,n =52;69.4％,n =111; 70.6％,n =113 ).The choices of C/S depended on the existences of maternal,fetal,social-psychological and others factors during pregnancy.Most pregnant women and families who chose C/S without medical indications were afraid of pain ( 33.9％ ) or a failure of vaginal delivery ( 30.5％ ).Conclusions The social-psychological factors of pregnant women are important in the choices of delivery modes.Unnecessary C/S could be reduced by improving their knowledge of delivery with meticulous prenatal health care consultations. Key words: Parturition; Cesarean section; Community health services