Institute for Clinical Effectiveness and Health Policy IECS, Dr, Emilio Ravignani 2024, C1414CPV, Buenos Aires, Argentina.
Reprod Health. 2013 Jan 14;10(1):2. doi: 10.1186/1742-4755-10-2.
Over the last three decades, cesarean section (CS) rates have been rising around the world despite no associated improvement in maternal and perinatal mortality and morbidity. The role of women's preferences for mode of delivery in contributing to the high CS rate remains controversial; however these preferences are difficult to assess, as they are influenced by culture, knowledge of risk and benefits, and personal and social factors. In this qualitative study, our objective was to understand women's preferences and motivational factors for mode of delivery. This information will inform the development and design of an assessment aimed at understanding the role of the women's preferences for mode of delivery.
We conducted 4 focus group discussions (FGDs) and 12 in-depth interviews with pregnant women in Buenos Aires, Argentina in 4 large non-public and public hospitals. Our sample included 29 nulliparous pregnant women aged 18-35 years old, with single pregnancies over 32 weeks of gestational age, without pregnancies resulting from assisted fertility, without known pre-existing medical illness or diseases diagnosed during pregnancy, without an indication of elective cesarean section, and who are not health professionals. FGDs and interviews followed a pre-designed guide based on the health belief model and social cognitive theory of health decisions and behaviors.
Most of the women preferred vaginal delivery (VD) due to cultural, personal, and social factors. VD was viewed as normal, healthy, and a natural rite of passage from womanhood to motherhood. Pain associated with vaginal delivery was viewed positively. In contrast, women viewed CS as a medical decision and often deferred decisions to medical staff in the presence of medical indication.
These findings converge with quantitative and qualitative studies showing that women prefer towards VD for various cultural, personal and social reasons. Actual CS rates appear to diverge from women's preferences and reasons are discussed.
尽管剖宫产（CS）率的上升并未带来孕产妇和围产儿死亡率和发病率的改善，但在过去三十年中，全球范围内 CS 率一直在上升。然而，产妇对分娩方式的偏好在导致高剖宫产率方面的作用仍存在争议；然而，这些偏好很难评估，因为它们受到文化、对风险和收益的了解、个人和社会因素的影响。在这项定性研究中，我们的目的是了解女性对分娩方式的偏好和动机因素。这些信息将为评估女性对分娩方式的偏好作用的开发和设计提供信息。
我们在阿根廷布宜诺斯艾利斯的 4 家大型非公立和公立医院进行了 4 次焦点小组讨论（FGD）和 12 次深度访谈。我们的样本包括 29 名年龄在 18-35 岁之间的初产妇，单胎妊娠超过 32 周，无辅助生育妊娠，无已知既往疾病或妊娠期间诊断的疾病，无选择性剖宫产指征，且非卫生专业人员。FGD 和访谈遵循基于健康信念模型和健康决策与行为的社会认知理论的预先设计指南。
大多数女性更喜欢阴道分娩（VD），因为文化、个人和社会因素。VD 被视为正常、健康的，是从女性到母亲的自然过渡。与阴道分娩相关的疼痛被视为积极的。相比之下，女性将 CS 视为一种医疗决策，并且在存在医疗指征的情况下，经常将决策推迟给医务人员。
这些发现与定量和定性研究一致，表明女性出于各种文化、个人和社会原因倾向于 VD。实际的 CS 率似乎与女性的偏好不同，原因正在讨论中。
