Lightly Kate, Mundle Shuchita, Tripathy Jaya, Deshmukh Pradeep, Winikoff Beverly, Weeks Andrew, Kingdon Carol
Department of Womens and Child Health, University of Liverpool, Liverpool, UK
Obstetrics and Gynaecology, AIIMS Nagpur, Nagpur, Maharashtra, India.
BMJ Glob Health. 2025 Sep 5;10(9):e018393. doi: 10.1136/bmjgh-2024-018393.
Caesarean use in India continues to rise and significant disparities exist. However, women and clinicians' views are under-researched. This paper aims to explore women and clinicians' views and preferences for mode of birth in two government hospitals in urban central India.
This qualitative study involved 53 semistructured interviews with high-risk women before and after induction of labour and eight focus groups with clinicians and researchers in two government hospitals in Maharashtra state. All women were recruited to the 'Misoprostol or Oxytocin for Labour Induction' (MOLI) randomised controlled trial (NCT03749902) and were induced for hypertensive disorders in pregnancy. Data were analysed using the framework approach to thematic analysis.
Interactions between women, clinicians and families played an important role in women's birth experiences. Most women strongly preferred vaginal birth. While a vaginal birth was important to women for their long-term health and well-being, the safety of the baby was the priority. Both women and clinicians justified caesarean use to promote fetal safety. Contrary to clinicians' perceptions, women clearly understood their caesarean indications. The busy clinical environment was an important factor influencing the clinician's decision and threshold for caesarean. Three themes arose from the data: (1) women's preference for vaginal birth: a matter of 'Trouble for two hours or trouble for two months'; (2) clinicians' perspectives about caesarean use: 'Don't take a risk'; and (3) knowledge through experiences and interactions: 'The pain didn't come'.
Women strongly preferred 'normal delivery' but accepted caesarean birth to promote fetal safety. Clinicians felt labour and vaginal birth were often risky and prioritised fetal safety in this under-resourced context. Women who had a caesarean birth understood their indication for caesarean but, compared with vaginal birth, reported that caesarean caused them additional short- and long-term anxiety, health and social concerns.
NCT04037683.
印度剖宫产的使用率持续上升，且存在显著差异。然而，对于女性和临床医生的观点研究不足。本文旨在探讨印度中部城市两家政府医院中女性和临床医生对于分娩方式的观点及偏好。
这项定性研究包括对53名高危女性在引产前后进行的半结构式访谈，以及在马哈拉施特拉邦两家政府医院与临床医生和研究人员进行的8次焦点小组讨论。所有女性均被纳入“米索前列醇或缩宫素引产”（MOLI）随机对照试验（NCT03749902），因妊娠期高血压疾病而接受引产。数据采用框架法进行主题分析。
女性、临床医生和家庭之间的互动在女性的分娩经历中起着重要作用。大多数女性强烈倾向于阴道分娩。虽然阴道分娩对女性的长期健康和幸福很重要，但婴儿的安全是首要考虑因素。女性和临床医生都认为剖宫产有助于保障胎儿安全。与临床医生的认知相反，女性清楚地了解自己的剖宫产指征。繁忙的临床环境是影响临床医生剖宫产决策和阈值的重要因素。数据产生了三个主题：（1）女性对阴道分娩的偏好：“两小时的麻烦还是两个月的麻烦”；（2）临床医生对剖宫产使用的看法：“不要冒险”；（3）通过经验和互动获得的认知：“疼痛并未出现”。
女性强烈倾向于“顺产”，但为了保障胎儿安全接受剖宫产。临床医生认为分娩和阴道分娩往往存在风险，在这种资源匮乏的情况下将胎儿安全置于首位。接受剖宫产的女性理解自己的剖宫产指征，但与阴道分娩相比，她们表示剖宫产给她们带来了额外的短期和长期焦虑、健康及社会问题。
NCT04037683。
