Kingdon Carol, Baker Lisa, Lavender Tina
Department of Midwifery Studies, University of Central Lancashire, Preston, Lancashire, UK.
Birth. 2006 Sep;33(3):229-37. doi: 10.1111/j.1523-536X.2006.00108.x.
The suggestion that planned cesarean birth is gaining acceptance among women has led some physicians to advocate the need for a trial of primary planned cesarean section versus planned vaginal birth in healthy women with singleton cephalic pregnancies at term. This paper reviews published studies of nulliparous women's views of mode of birth collected in the antenatal period, examining why women may express a preference for cesarean birth and exploring implications for the debate about the need for a trial.
A systematic literature review was undertaken of Cochrane, CINAHL, EMBASE, MEDLINE, and PsycINFO using the MeSH heading "cesarean section" and four free text spellings of "cesarean," or "birth" or "delivery," near truncated synonyms of 17 words meaning expressed preference. Studies of nulliparous women with a medical indication for cesarean birth, studies where a woman's preference for mode of birth was reported in the postpartum period, surveys of midwives or obstetricians, and opinion and non-English language papers were all excluded.
Nine papers were included in the review, which reported rates of women expressing a preference for cesarean birth that ranged from 0 to 100 percent at recruitment. However, the papers raised specific methodological, conceptual, and cultural issues that may have influenced women's preferences for mode of birth in the populations studied. These issues included the timing and frequency of data collection, complexity of factors determining individual women's decision making, and influence of societal norms.
Little evidence is available that an increasing cultural acceptance of cesarean delivery will bring about support for a trial among pregnant nulliparous women. Further qualitative research investigating the influence of both obstetric and psychosocial factors on women's views of vaginal and cesarean birth is required.
有观点认为计划剖宫产在女性中越来越被接受，这使得一些医生主张，对于足月单胎头位妊娠的健康女性，有必要对首次计划剖宫产与计划阴道分娩进行对比试验。本文回顾了已发表的关于未生育女性在孕期对分娩方式看法的研究，探讨女性可能更倾向于剖宫产的原因，并探究这一争论对是否需要进行试验的影响。
使用主题词“剖宫产”以及“剖宫产”“分娩”或“生产”的四种自由文本拼写形式，在Cochrane、CINAHL、EMBASE、MEDLINE和PsycINFO数据库中进行系统文献综述，这些拼写形式与17个表示偏好的近截短同义词相近。排除有剖宫产医学指征的未生育女性的研究、报告女性产后对分娩方式偏好的研究、对助产士或产科医生的调查以及观点类和非英语语言的论文。
该综述纳入了9篇论文，这些论文报告了在招募时表示倾向于剖宫产的女性比例，范围从0%到100%。然而，这些论文提出了一些特定的方法学、概念和文化问题，这些问题可能影响了所研究人群中女性对分娩方式的偏好。这些问题包括数据收集的时间和频率、决定个体女性决策过程的因素的复杂性以及社会规范的影响。
几乎没有证据表明剖宫产在文化上越来越被接受会促使未生育孕妇支持进行这样的试验。需要进一步开展定性研究，调查产科因素和心理社会因素对女性对阴道分娩和剖宫产看法的影响。
