Factors contributing to the rapid rise of caesarean section: a prospective study of primiparous Chinese women in Shanghai.

Journal Article (Journal Article;Multicenter Study)

OBJECTIVE: To identify factors contributing to the rapid rise of caesarean section in Shanghai through the prospective observation of changes in the preferred mode of delivery in pregnancy among primiparous Chinese women. DESIGN: Prospective study. SETTING: Two general hospitals in Shanghai. PARTICIPANTS: A cohort of 832 low-risk primiparous women participated in the investigation from 2010-2012 three consecutive times, from their second to third trimester and, finally, 1-2 days post partum. METHODS: Participants were interviewed, using standard questionnaires, for information on demographic characteristics, maternal childbirth self-efficacy, their preference of delivery mode before childbirth and on the people most influential to them when making decisions on delivery mode. Caesarean section indications in the medical records were extracted by the investigators and assessed against clinical guidelines. Caesarean sections were categorised into three groups: guideline-defined indications, doctor-defined indications and maternal request. MAIN OUTCOME MEASURES: Preferred mode of delivery; indications for caesarean section; actual mode of delivery; determinants of caesarean section. RESULTS: Of 832 pregnant women enrolled, 13.2% preferred caesarean section in the second trimester. This figure rose to 17.0% in the third trimester among 599 followed women. Of 523 women completing all three interviews, 58.1% underwent caesarean section. However, 34.9% of women undergoing caesarean section did not have any indications listed in the clinical guidelines nor based on maternal request. Multinomial regression analysis showed that doctors' influence was one of the significant risk factors of undergoing caesarean section, with doctor-defined indications. Participants with low maternal childbirth self-efficacy were more likely to request caesarean sections themselves. CONCLUSIONS: When deciding to deliver via caesarean section without justified clinical indications in the guideline, Chinese doctors played an important role in decision-making. Among primiparous Chinese women, decisions to use caesarean sections were often made during the third trimester or during the process of labour.

Full Text

Duke Authors

Cited Authors

  • Ji, H; Jiang, H; Yang, L; Qian, X; Tang, S

Published Date

  • November 13, 2015

Published In

Volume / Issue

  • 5 / 11

Start / End Page

  • e008994 -

PubMed ID

  • 26567254

Pubmed Central ID

  • PMC4654304

Electronic International Standard Serial Number (EISSN)

  • 2044-6055

Digital Object Identifier (DOI)

  • 10.1136/bmjopen-2015-008994


  • eng

Conference Location

  • England