Deng Wei, Klemetti Reija, Long Qian, Wu Zhuochun, Duan Chenggang, Zhang Wei-Hong, Ronsmans Carine, Zhang Yu, Hemminki Elina
School of Public Health, Fudan University, 138 Yi Xue Yuan Road, P,O, Box 250, Shanghai 200032, China.
BMC Pregnancy Childbirth. 2014 Aug 22;14:285. doi: 10.1186/1471-2393-14-285.
Cesarean section (CS) rate has increased rapidly over the past two decades in China mainly driven by non-medical factors. This study was to compare recalled preferences for CS among first-time mothers in early and late pregnancy with actual delivery mode; to explore factors related to CS preference and CS performed without medical indications; and to consider the role of healthcare providers in delivery mode preferences.
An anonymous questionnaire survey, combined with data on CS indications taken from the patient record, was conducted among 272 first-time mothers having their first postnatal check-up in one university affiliated obstetrics and gynecology hospital in Shanghai, China, between September 2006 and January 2007. Logistic regression was used to study factors related to the recalled preference for CS and CS performed without medical indication, adjusting for maternal age, education and income.
The CS rate was 57% (151/263) among all women, 17% with medical indications and 40% without medical indications. For women without medical indications for CS (n = 215), there was no significant difference between women's preference for CS in early (25%) and late pregnancy (28%); 48% of women actually had CS. Women recalled preferring a vaginal delivery but who had CS were more likely to have had a CS suggested by a prenatal care doctor [OR (95% CI): 20 (3.88-107.1)] or by a delivery obstetrician [OR (95% CI): 26 (6.26-105.8)]. Among women recalled preferring and having CS, a suggestion from the prenatal care doctor to have CS was very common.
In the primiparous women without a medical indication for CS, women recall of a provider suggestion for CS was a strong predictor of CS both among women who recalled a preference for CS and among women who recalled a preference for vaginal delivery. Public health education needs strengthening, including discussion of the risks associated with CS and psychological and social support given to women to help them prepare for and cope with childbirth.
在过去二十年中，中国剖宫产率迅速上升，主要是由非医学因素驱动。本研究旨在比较初产妇在妊娠早期和晚期回忆起的剖宫产偏好与实际分娩方式；探讨与剖宫产偏好及无医学指征剖宫产相关的因素；并考量医疗服务提供者在分娩方式偏好中的作用。
2006年9月至2007年1月期间，在中国上海一家大学附属妇产科医院，对272名首次进行产后检查的初产妇进行了匿名问卷调查，并结合从病历中获取的剖宫产指征数据。采用逻辑回归分析与剖宫产回忆偏好及无医学指征剖宫产相关的因素，并对产妇年龄、教育程度和收入进行了校正。
所有女性的剖宫产率为57%（151/263），其中有医学指征的占17%，无医学指征的占40%。对于无剖宫产医学指征的女性（n = 215），她们在妊娠早期（25%）和晚期（28%）对剖宫产的偏好无显著差异；48%的女性实际进行了剖宫产。回忆中倾向于顺产但最终进行了剖宫产的女性，更有可能是因为产前检查医生[比值比（95%置信区间）：20（3.88 - 107.1）]或分娩产科医生[比值比（95%置信区间）：26（6.26 - 105.8）]建议进行剖宫产。在回忆中倾向并进行了剖宫产的女性中，产前检查医生建议剖宫产的情况很常见。
在无剖宫产医学指征的初产妇中，无论是回忆中倾向于剖宫产的女性，还是回忆中倾向于顺产的女性，医生建议剖宫产都是剖宫产的一个强有力预测因素。需要加强公共卫生教育，包括讨论剖宫产相关风险以及为女性提供心理和社会支持，以帮助她们为分娩做好准备并应对分娩过程。
