Women's preference for cesarean delivery and differences between Taiwanese women undergoing different modes of delivery
The rate of cesarean delivery was 35% in 2007 in Taiwan. It is unclear how many of the cesarean deliveries were without medical indications. Women's preference for cesarean delivery during their course of pregnancy has rarely been studied and therefore our objectives were to examine rate of cesarean deliveries without medical indications, to explore women's preference for cesarean delivery as their gestation advances, and to compare background and perinatal factors among women who underwent different modes of delivery in Taiwan.
This prospective study applied a longitudinal design. The study participants were 473 women who received prenatal care at four hospitals in Taipei and answered structured questionnaires at 20 to 24 weeks of pregnancy, 34 to 36 weeks of pregnancy, and 5 to 7 weeks after delivery.
Of the 151 women (31.9%) who had cesarean deliveries, 19.9% were without medical indication. Three indications: malpresentation, prior cesarean section, and dysfunctional labor together accounted for 82.6% of cesarean section with medical indications. The prevalence of maternal preference for cesarean delivery was found to be 12.5% and 17.5% during the second and third trimester, respectively. Of the women who preferred cesarean delivery during the second trimester, 93.2% eventually had a cesarean delivery. Women who were older, with older spouses, and who had health problems before or during pregnancy were more likely to have cesarean deliveries.
About 20% of cesarean deliveries were without medical indications. Women's preference for cesarean delivery during the second trimester predicts subsequent cesarean delivery. Counseling regarding mode of delivery should be offered early in pregnancy, especially for women who are older or with older spouses, have health problems, or had a prior cesarean section.
- Chao LM: Preliminary experience in vaginal birth after cesarean. J Midwifery 2001, 44:18–23. in Chinese
- Department of Health, Taiwan: Table 13 Average daily medical services provision, 2009.
- Chou YJ, Huang N, Lin IF, Deng CY, Tsai YW, Lee CH: Do physicians and their relatives have a decreased rate of cesarean section? A 4-year population-based study in Taiwan. Birth 2006,33(3):195–202. CrossRef
- Lydon-Rochelle M, Holt VL, Martin DP, Easterling TR: Association between method of delivery and maternal rehospitalization. JAMA 2003,289(1):46–47. CrossRef
- Tang CH, Wang HI, Hsu CS, Su HW, Chen MJ, Lin HC: Risk-adjusted cesarean section rates for the assessment of physician performance in Taiwan: a population-based study. BMC Public Health 2006, 6:246. CrossRef
- Lin HC, Xirasagar S, Tung YC: Impact of a cultural belief about ghost month on delivery mode in Taiwan. J Epidemiol Community Health 2006,60(6):522–526. CrossRef
- Taiwan's National HealthInsurance: Caesarean section rate, 2008.
- Taiwan's National HealthInsurance: Indicators for quality of care: Rate of caesarean section, 2007. [http://www.nhi.gov.tw/webdata/AttachFiles/Attach_5077_2_1.10.pdf]
- Department of Health, Taiwan: Birth registry 2008. [http://www.bhp.doh.gov.tw/download/themeParkId=542/970808/1.11a.pdf]
- World Health Organization: Appropriate technology for birth. Lancet 1985, 2:436–437.
- Chien LY, Tai CJ, Ko YL, Huang CH, Sheu SJ: Adherence to "Doing the Month" practices is associated with fewer? physical and depressive symptoms among postpartum women in Taiwan. Res Nursing Health 2006, 29:374–383. CrossRef
- Chigbu CO, Ezeome IV, Iloabachie GC: Cesarean section on request in a developing country. Int J Gynaecol Obstet 2007,96(1):54–56. CrossRef
- Lin HC, Xirasagar S: Maternal age and the likelihood of a maternal request for cesarean delivery: a 5-year population-based study. Am J Obstet Gynecol 2005,192(3):8488–8455. CrossRef
- Bureau of National Health Insurance Taiwan: Notes for reviewing hospital claims: Obstetrics & Gynecology.
- Hsu CY, Lo JC, Chang JH, Chen CP, Yu S, Huang FY: Cesarean births in Taiwan. Int J Gynaecol Obstet 2007,96(1):57–61. CrossRef
- Pang MW, Lee TS, Leung AK, Leung TY, Lau TK, Leung TN: A longitudinal observational study of preference for elective caesarean section among nulliparous Hong Kong Chinese women. Br J Obstet Gynaecol 2007,114(5):623–629. CrossRef
- Declercq ER, Sakala C, Corry MP, Applebaum S: Listening to Mothers II: Report of the Second National U.S. Survey of Women's Childbearing Experiences: Conducted January-February 2006 for Childbirth Connection by Harris Interactive(R) in partnership with Lamaze International. J Perinat Educ 2007,16(4):9–14. CrossRef
- Gamble JA, Creedy DK: Women's preference for a cesarean section: incidence and associated factors. Birth 2001,28(2):101–110. CrossRef
- Weaver JJ, Statham H, Richards M: Are there 'unnecessary' cesarean sections? Perceptions of women and obstetricians about cesarean sections for nonclinical indications. Birth 2007,34(3):273–274. CrossRef
- Liu TC, Chen CS, Tsai YW, Lin HC: Taiwan's high rate of cesarean births: impacts of national health insurance and fetal gender preference. Birth 2007,34(2):115–122. CrossRef
- Tang CH, Wu MP, Liu JT: Delayed parenthood? and the risk of cesarean delivery-is paternal age an independent risk factor? Birth 2006,33(1):18–26. CrossRef
- Lin HC, Sheen TC, Tang CH, Kao S: Association between maternal age and the likelihood of a cesarean section: a population-based multivariate logistic regression analysis. Acta Obstet Gynecol Scand 2004,83(12):1178–1183.
- Roman H, Blondel B, Bréart G, Goffinet F: Do risk factors for elective cesarean section differ from those of cesarean section during labor in low risk pregnancies? J Perinatal Med 2008,36(4):297–305. CrossRef
- Mancuso A, De Vivo A, Fanara G: Women's preference on mode of delivery in Southern Italy. Acta Obstet Gynecol Scand 2006,85(6):694–699. CrossRef
- Hsu KH, Liao PJ, Hwang CJ: Factors affecting Taiwanese women's choice of Cesarean section. Soc Sci Med 2008,66(1):201–209. CrossRef
- Hamilton BE, Martin JA, Sutton PD: Births: preliminary data for 2002. Natl Vital Stat Rep 2003, 51:1–20.
- Menacker F, Curtin SC: Trends in cesarean birth and vaginal birth after previous cesarean 1991–99. Natl Vital Stat Rep 2001, 49:1–16.
- Bujold E, Gauthier RJ, Hamilton E: Maternal and perinatal outcomes associated with a trial of labor after prior cesarean delivery. New Engl J Medicine 2004,351(25):2581–2589. CrossRef
- Liu SC, Li HJ, Lee SH: The experiences of multipara who chose to undergo vaginal birth after cesarean. J Evidence-Based Nursing 2006,2(3):242–249. [in Chinese]
- Shorten A, Shorten B, Keogh J: Making choices for childbirth: a randomized controlled trial of a decision-aid for informed birth after cesarean. Birth 2005,32(4):252–261. CrossRef
- Department of Statistics, Ministry of the Interior: Interior statistical report, the twenty-first week of year 2008. [http://moe.familyedu.moe.gov.tw/ezcatfiles/d001/download/attach/4/05..doc]
- The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1472-6963/10/138/prepub
- Women's preference for cesarean delivery and differences between Taiwanese women undergoing different modes of delivery
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- Available under Open Access This content is freely available online to anyone, anywhere at any time.
BMC Health Services Research
- Online Date
- May 2010
- Online ISSN
- BioMed Central
- Additional Links
- Author Affiliations
- 1. Department of Nursing, Chang Gung Institute of Technology, Taoyuan, Taiwan
- 2. Department of Traditional Chinese Medicine, Taipei Medical University Hospital and Department of Medicine, Taipei Medical University, Taipei, Taiwan
- 3. Department of Obstetrics and Gynecology, Taipei Medical University-Wanfang Hospital and Department of Medicine, Taipei Medical University, Taipei, Taiwan
- 4. Institute of Clinical and Community Health Nursing, National Yang-Ming University, Taipei, Taiwan