School of Population & Public Health & Division of Midwifery, University of British Columbia, 2206 E Mall, Vancouver, BC, V6T 1Z9, Canada.
School of Nursing, Midwifery and Paramedicine, Curtin University and King Edward Memorial Hospital, Perth, WA, Australia.
Reprod Health. 2017 Sep 12;14(1):116. doi: 10.1186/s12978-017-0354-x.
Efforts to reduce unnecessary Cesarean sections (CS) in high and middle income countries have focused on changing hospital cultures and policies, care provider attitudes and behaviors, and increasing women's knowledge about the benefits of vaginal birth. These strategies have been largely ineffective. Despite evidence that women have well-developed preferences for mode of delivery prior to conceiving their first child, few studies and no interventions have targeted the next generation of maternity care consumers. The objectives of the study were to identify how many women prefer Cesarean section in a hypothetical healthy pregnancy, why they prefer CS and whether women report knowledge gaps about pregnancy and childbirth that can inform educational interventions.
Data was collected via an online survey at colleges and universities in 8 OECD countries (Australia, Canada, Chile, England, Germany, Iceland, New Zealand, United States) in 2014/2015. Childless young men and women between 18 and 40 years of age who planned to have at least one child in the future were eligible to participate. The current analysis is focused on the attitudes of women (n = 3616); rates of CS preference across countries are compared, using a standardized cohort of women aged 18-25 years, who were born in the survey country and did not study health sciences (n = 1390).
One in ten young women in our study preferred CS, ranging from 7.6% in Iceland to 18.4% in Australia. Fear of uncontrollable labor pain and fear of physical damage were primary reasons for preferring a CS. Both fear of childbirth and preferences for CS declined as the level of confidence in women's knowledge of pregnancy and birth increased.
Education sessions delivered online, through social media, and face-to-face using drama and stories told by peers (young women who have recently had babies) or celebrities could be designed to maximize young women's capacity to understand the physiology of labor and birth, and the range of methods available to support them in coping with labor pain and to minimize invasive procedures, therefore reducing fear of pain, bodily damage, and loss of control. The most efficacious designs and content for such education for young women and girls remains to be tested in future studies.
在高收入和中等收入国家，为减少不必要的剖宫产（CS），人们主要致力于改变医院文化和政策、医护人员的态度和行为，并提高女性对阴道分娩益处的认识。但这些策略收效甚微。尽管有证据表明，女性在怀第一个孩子之前就已经对分娩方式有了成熟的偏好，但很少有研究或干预措施针对下一代产妇保健消费者。本研究的目的是确定有多少女性在假设的健康妊娠中更喜欢剖宫产，她们为什么更喜欢 CS，以及女性是否报告了有关妊娠和分娩的知识差距，这些差距可以为教育干预提供信息。
本研究于 2014-2015 年在 8 个经合组织国家（澳大利亚、加拿大、智利、英格兰、德国、冰岛、新西兰和美国）的学院和大学通过在线调查收集数据。符合条件的参与者为年龄在 18-40 岁之间、无子女、计划未来至少生育一个孩子的年轻男性和女性。目前的分析主要关注女性的态度（n=3616）；使用标准化的 18-25 岁调查国出生且未学习健康科学的女性队列（n=1390）比较了各国 CS 偏好率。
我们的研究中有十分之一的年轻女性更喜欢 CS，从冰岛的 7.6%到澳大利亚的 18.4%不等。对无法控制的分娩疼痛的恐惧和对身体损伤的恐惧是首选 CS 的主要原因。对分娩的恐惧和对 CS 的偏好都随着女性对妊娠和分娩知识的信心增加而下降。
可以通过在线教育课程、通过社交媒体以及通过戏剧和由最近分娩的年轻女性或名人讲述的故事进行面对面的教育课程，设计最大程度地提高年轻女性理解分娩生理过程以及可用的各种方法的能力，以帮助她们应对分娩疼痛并减少侵入性程序，从而减少对疼痛、身体损伤和失去控制的恐惧。对于年轻女性和女孩，这种教育的最有效设计和内容仍有待未来研究检验。
