Schantz Clémence, Sim Kruy Leang, Petit Véronique, Rany Heng, Goyet Sophie
Midwife-PhD, Centre Population et Développement (Ceped), UMR 196: IRD (Institut de Recherche pour le Développement), Paris France.
Obstetrician, Calmette Maternity Hospital, Phnom Penh, Cambodia.
Reprod Health Matters. 2016 Nov;24(48):111-121. doi: 10.1016/j.rhm.2016.11.009. Epub 2016 Dec 10.
C-sections are an increasingly performed medical practice which can save lives but may also lead to major complications. Through a mixed methods study conducted in 2015 in Cambodia, we aimed to analyze the reasons for requesting a c-section and to explore factors that are associated with c-sections. 60% of the women in the cohort who gave birth by c-section reported having requested it. Through 31 in-depth interviews, we determined the reasons given by women for requesting a c-section before and during labour. Before labour, reasons for requesting a c-section were: choosing the delivery date; bringing luck and joy to the family; protecting the genitals, and the belief that c-section is safer for the mother and for the baby. Reasons given during labour were fear, pain, and having no more energy. We also observed two major factors driving the women's request for a c-section: family support for requesting a c-section, and the over-usage of ultrasound examinations. Our multivariate analysis of the interviews of 143 women before and after delivery showed that having a previous c-section, delivering in a private facility, being older than median at the time of sexual debut, residing outside of Phnom Penh and having the delivery costs covered by the family were all factors independently and significantly associated with a higher chance of c-section delivery. We conclude that women are not well informed to give consent for c-delivery, and that their request is often affected by false belief and poor knowledge.
剖宫产是一种实施越来越频繁的医疗行为，它能挽救生命，但也可能导致严重并发症。通过2015年在柬埔寨进行的一项混合方法研究，我们旨在分析要求进行剖宫产的原因，并探究与剖宫产相关的因素。该队列中通过剖宫产分娩的女性中有60%报告是自己要求进行剖宫产的。通过31次深入访谈，我们确定了女性在分娩前和分娩过程中要求进行剖宫产的原因。分娩前要求进行剖宫产的原因有：选择分娩日期；给家庭带来好运和喜悦；保护生殖器，以及认为剖宫产对母亲和婴儿更安全。分娩过程中给出的原因是恐惧、疼痛和没有力气了。我们还观察到促使女性要求进行剖宫产的两个主要因素：家庭对要求剖宫产的支持，以及超声检查的过度使用。我们对143名女性分娩前后访谈的多变量分析表明，既往有剖宫产史、在私立机构分娩、首次性行为时年龄大于中位数、居住在金边以外以及分娩费用由家庭承担，这些都是与剖宫产分娩几率较高独立且显著相关的因素。我们得出结论，女性在同意剖宫产方面没有得到充分的信息告知，她们的要求往往受到错误观念和知识匮乏的影响。
