Gender and Women's Health Unit, Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
Gender and Women's Health Unit, Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia.
BMJ Glob Health. 2024 Jun 18;9(6):e014602. doi: 10.1136/bmjgh-2023-014602.
Caesarean section (CS) rates in Indonesia are increasing rapidly. Understanding women's preferences about mode of birth is important to help contextualise these rising rates and can help develop interventions to optimise CS. This study aimed to explore Indonesian women's preferences and decision-making about mode of birth, and how their preferences may change throughout pregnancy and birth.
We conducted a longitudinal qualitative study using in-depth interviews with 28 women accessing private and public health facilities in Jakarta, the region with the highest CS rates. Interviews were conducted two times: during the woman's third trimester of pregnancy and in the postpartum period, between October 2022 and March 2023. We used a reflexive thematic approach for analysis.
We generated three themes: (1) preferences about the mode of birth, (2) decision-making about the mode of birth and (3) regrets about the actual mode of birth. Most women preferred vaginal birth. However, they were influenced by advertisements promoting enhanced recovery after CS (ERACS) as an 'advanced technique' of CS, promising a comfortable, painless and faster recovery birth. This messaging influenced women to perceive CS as equivalent or even superior to vaginal birth. Where women's preferences for mode of birth shifted around the time of birth, this was primarily due to the obstetricians' discretion. Women felt they did not receive adequate information from obstetricians on the benefits and risks of CS and vaginal birth and felt disappointed when their actual mode of birth was not aligned with their preferences.
Our study shows that despite rising CS rates, Indonesian women prefer vaginal birth. This highlights the need for better communication strategies and evidence-based information from healthcare providers. Given the rising popularity of ERACS, more work is urgently needed to standardise and regulate its use.
印度尼西亚的剖宫产率正在迅速上升。了解女性对分娩方式的偏好对于理解这些上升的比率非常重要，并且可以帮助制定干预措施以优化剖宫产率。本研究旨在探讨印度尼西亚女性对分娩方式的偏好和决策，以及她们的偏好如何在整个孕期和分娩过程中发生变化。
我们使用深入访谈法对 28 名在雅加达的私立和公立医疗机构就诊的女性进行了一项纵向定性研究，雅加达是剖宫产率最高的地区。访谈在女性妊娠的第三个三个月和产后期间进行，时间为 2022 年 10 月至 2023 年 3 月。我们使用反思性主题分析方法进行分析。
我们生成了三个主题：（1）对分娩方式的偏好，（2）对分娩方式的决策，（3）对实际分娩方式的遗憾。大多数女性更喜欢阴道分娩。然而，她们受到广告的影响，这些广告将增强剖宫产术后恢复（ERACS）宣传为 CS 的“先进技术”，承诺舒适、无痛和更快的恢复分娩。这种信息影响了女性对 CS 与阴道分娩同等甚至更优的看法。当女性对分娩方式的偏好在分娩时发生变化时，这主要是由于产科医生的裁量权。女性感到她们没有从产科医生那里获得足够的关于 CS 和阴道分娩的益处和风险的信息，并且当她们的实际分娩方式与偏好不一致时感到失望。
我们的研究表明，尽管剖宫产率上升，但印度尼西亚女性仍更喜欢阴道分娩。这凸显了需要改善医疗保健提供者的沟通策略和基于证据的信息。鉴于 ERACS 的普及，迫切需要更多的工作来规范和监管其使用。
