Pakenham Susan, Chamberlain Susan M, Smith Graeme N
Department of Obstetrics & Gynaecology, Queen's University, Kingston ON.
J Obstet Gynaecol Can. 2006 Dec;28(12):1089-1094. doi: 10.1016/S1701-2163(16)32335-0.
Elective primary Caesarean section (EPCS), Caesarean section performed at a woman's request in the absence of a recognized obstetrical indication, is becoming increasingly common. Recent articles and opinions in both the medical and lay press have polarized this issue. The purpose of this study was to determine the opinions and choices of nulliparous and multiparous women with respect to mode of delivery.
All women attending antenatal clinics at Kingston General Hospital from May to August 2005 were invited to participate in a confidential survey. Basic demographic data including maternal age, level of education, parity, and previous mode of delivery were collected. Respondents who had had a previous Caesarean section were excluded from data analysis. The questionnaire provided a written statement of potential benefits and risks of an EPCS compared with vaginal delivery; no other counselling was provided. Respondents were asked if EPCS should be offered to all women and whether they would choose EPCS if given the choice. Respondents were also asked to indicate the most and least influential factors in their decision.
Responses were received from 107 nulliparous women and 103 multiparous women. Thirteen percent of nulliparas (14/107) stated that they would choose EPCS if given the option, compared with 5% of multiparas (5/103). Fifty-one percent of nulliparas (55/107) and 28% of multiparas (29/103) believed that EPCS should be offered to all women receiving antenatal care. The most and least important reasons, chosen from a list, for requesting or declining EPCS varied between nulliparas and multiparas. The convenience of scheduling permitted by Caesarean section was not important for either multiparas or nulliparas. The perceived risks of vaginal delivery were commonly cited by both nulliparas and multiparas as reasons for requesting EPCS, whereas the risks of Caesarean section for the baby or for future pregnancies were the most commonly cited reasons to decline EPCS in both groups. Regardless of the decision to request or decline EPCS, cost to the health care system was not an important factor for either nulliparas or multiparas.
The majority of pregnant women surveyed would not request an EPCS. However, a significant number of pregnant women, both nulliparous and multiparous, felt that women should be given the option of undergoing EPCS.
择期剖宫产（EPCS），即在无公认产科指征情况下应产妇要求实施的剖宫产，正变得越来越普遍。医学和大众媒体近期的文章及观点使这个问题两极分化。本研究的目的是确定初产妇和经产妇对于分娩方式的意见和选择。
邀请2005年5月至8月在金斯顿综合医院产前门诊就诊的所有女性参与一项保密调查。收集了包括产妇年龄、教育程度、产次和既往分娩方式在内的基本人口统计学数据。曾有过剖宫产史的受访者被排除在数据分析之外。问卷提供了一份关于择期剖宫产与阴道分娩相比潜在益处和风险的书面说明；未提供其他咨询。询问受访者是否应向所有女性提供择期剖宫产，以及如果有选择她们是否会选择择期剖宫产。还要求受访者指出其决定中最具影响力和最不具影响力的因素。
收到了107名初产妇和103名经产妇的回复。13%的初产妇（14/107）表示如果有选择她们会选择择期剖宫产，相比之下经产妇为5%（5/103）。51%的初产妇（55/107）和28%的经产妇（29/103）认为应向所有接受产前护理的女性提供择期剖宫产。从列出的清单中选择的要求或拒绝择期剖宫产的最重要和最不重要原因在初产妇和经产妇之间有所不同。剖宫产允许的日程安排便利性对经产妇和初产妇都不重要。初产妇和经产妇都普遍将阴道分娩的感知风险作为要求择期剖宫产的原因，而剖宫产对婴儿或未来妊娠的风险是两组中拒绝择期剖宫产最常提及的原因。无论决定要求还是拒绝择期剖宫产，医疗保健系统的成本对初产妇和经产妇都不是一个重要因素。
大多数接受调查的孕妇不会要求择期剖宫产。然而，相当数量的孕妇，包括初产妇和经产妇，认为应该给予女性接受择期剖宫产的选择。
