MAHEC Department of Obstetrics and Gynecology, 93 Victoria Rd., Asheville, NC 28801, USA.
Matern Child Health J. 2012 Apr;16(3):725-34. doi: 10.1007/s10995-011-0769-x.
Cesarean delivery on maternal request (CDMR), a primary cesarean without medical indication for a singleton, term pregnancy, has been identified by physicians as one factor in the increasing rate of cesarean delivery despite nationwide efforts to the contrary. The purpose of this project was to better understand women's preferences and motivations for their desired mode of delivery. A 62-item survey was administered to pregnant women asking for their delivery preference, their reasons, sources of information, feelings about this pregnancy, and opinions about delivery options. Responses were analyzed for candidates for CDMR or for repeat cesarean section, separately; the standard error of measure is ±4% (95% CI). 396 patients returned surveys (response rate = 63.2%). CDMR was desired by 34/316 (11%) candidates; repeat cesarean was desired by 32/70 (46%) patients. Significant correlates of CDMR included choosing during the first trimester (22% vs. 8.2%; RR = 2.72; P = 0.015), smoking during pregnancy (19.7% vs. 7.6%; RR = 2.60; P = 0.036), and being worried about the delivery (P = 0.004). Desire for CDMR increased as worries increased from unworried (4.4%) to somewhat (11.8%) to very worried (27.6%). Primary reasons included existing medical complications and preventing birth injury. The majority of patients believed CDMR should be an "informed choice"; other opinions varied by delivery preference. The majority of women preferred vaginal deliveries suggesting little contribution of CDMR to the increasing cesarean rate. Contrary to physicians' beliefs, the women's primary objective was their infants' health rather than their own well-being.
产妇要求的剖宫产（CDMR），即在没有医学指征的情况下对单胎足月妊娠行剖宫产，尽管全国范围内都在努力反对，但它仍是剖宫产率上升的一个因素。本项目的目的是更好地了解女性对其期望分娩方式的偏好和动机。向要求分娩的孕妇发放了一份 62 项的调查问卷，询问她们的分娩偏好、原因、信息来源、对此次妊娠的感受以及对分娩方式的看法。分别对要求行 CDMR 或再次剖宫产的孕妇的回答进行了分析；测量的标准误差为±4%（95%CI）。396 名患者返回了调查问卷（应答率为 63.2%）。316 名候选者中，34 名（11%）希望行 CDMR；70 名患者中，32 名（46%）希望再次行剖宫产。CDMR 的显著相关因素包括在孕早期选择（22%比 8.2%；RR=2.72；P=0.015）、孕期吸烟（19.7%比 7.6%；RR=2.60；P=0.036）和担心分娩（P=0.004）。随着担心程度从不担心（4.4%）到有些担心（11.8%）到非常担心（27.6%），对 CDMR 的渴望程度增加。主要原因包括现有的医疗并发症和预防分娩损伤。大多数患者认为 CDMR 应该是一个“知情选择”；其他观点因分娩偏好而异。大多数女性更喜欢阴道分娩，这表明 CDMR 对剖宫产率的上升贡献不大。与医生的看法相反，女性的主要目标是婴儿的健康，而不是自身的幸福。
