Impact of First Childbirth on Changes in Women's Preference for Mode of Delivery: Follow-up of a Longitudinal Observational Study

Background: A woman’s childbirth experience has an influence on her future preferred mode of delivery. This study aimed to identify determinants for women who changed from preferring a planned vaginal birth to an elective cesarean section after their first childbirth. Methods: This prospective longi...

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Published in:	Birth (Berkeley, Calif.) Vol. 35; no. 2; pp. 121 - 128
Main Authors:	Pang, Man Wah, Leung, Tse Ngong, Lau, Tze Kin, Hang Chung, Tony Kwok
Format:	Journal Article
Language:	English
Published:	Malden, USA Blackwell Publishing Inc 01-06-2008 Wiley Subscription Services, Inc
Subjects:	Adult Births Caesarean section cesarean section Cesarean Section - psychology Cesarean Section - statistics & numerical data Childbirth Childbirth & labor Chinese women Choice Behavior Cohort Studies delivery method Delivery, Obstetric - methods Delivery, Obstetric - psychology Elective Surgical Procedures - psychology Elective Surgical Procedures - statistics & numerical data Fear Female Health education Hong Kong Humans Longitudinal Studies Multivariate Analysis Obstetric Labor Complications - psychology Obstetrics Odds Ratio Parity Parturition Patient Satisfaction planned vaginal birth preference Preferences Pregnancy Pregnant Women - psychology Prenatal care Prospective Studies Second children Studies Vaginal birth Women Womens health Hong Kong
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Summary:	Background: A woman’s childbirth experience has an influence on her future preferred mode of delivery. This study aimed to identify determinants for women who changed from preferring a planned vaginal birth to an elective cesarean section after their first childbirth. Methods: This prospective longitudinal observational study involved two units that provide obstetric care in Hong Kong. A mail survey was sent to 259 women 6 months after their first childbirth. These women had participated in a longitudinal cohort study that examined their preference for elective cesarean section in the antenatal period of their first pregnancies. Univariate and multivariate analyses were performed to identify determinants for women who changed from preferring vaginal birth to elective cesarean section. Results: Twenty‐four percent (23.8%, 95% CI 18.4–29.3) of women changed from preferring vaginal birth to elective cesarean section after their first childbirth. Determinants found to be positively associated with this change included actual delivery by elective cesarean section (OR 106.3, 95% CI 14.7–767.4) intrauterine growth restriction (OR 19.5, 95% CI 1.1–353.6), actual delivery by emergency cesarean section (OR 8.4, 95% CI 3.4–20.6), higher family income (OR 3.2, 95% CI 1.1–8.8), use of epidural analgesia (OR 2.6, 95% CI 1.0–6.8), and higher trait anxiety score (OR 1.1, 95% CI 1.0–1.3). The most important reason for women who changed from preferring vaginal birth to elective cesarean section was fear of vaginal birth (24.4%). Conclusions: A significant proportion of women changed their preferred mode of delivery after their first childbirth. Apart from reducing the number of cesarean sections in nulliparous women, prompt provision of education to women who had complications and investigations into fear factors during vaginal birth might help in reducing women’s wish to change to elective cesarean section. (BIRTH 35:2 June 2008)
Bibliography:	istex:E0D355B37308DF8425D24D0EFE7F82D00604C163 ark:/67375/WNG-49F6CWKS-K ArticleID:BIRT225 ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Article-2 ObjectType-Feature-1
ISSN:	0730-7659 1523-536X
DOI:	10.1111/j.1523-536X.2008.00225.x