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Factors contributing to the rapid rise of caesarean section: a prospective study of primiparous Chinese women in Shanghai
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. PARTICI...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2015
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4654304/ https://www.ncbi.nlm.nih.gov/pubmed/26567254 http://dx.doi.org/10.1136/bmjopen-2015-008994 |
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author | Ji, Honglei Jiang, Hong Yang, Limin Qian, Xu Tang, Shenglan |
author_facet | Ji, Honglei Jiang, Hong Yang, Limin Qian, Xu Tang, Shenglan |
author_sort | Ji, Honglei |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-4654304 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-46543042015-12-02 Factors contributing to the rapid rise of caesarean section: a prospective study of primiparous Chinese women in Shanghai Ji, Honglei Jiang, Hong Yang, Limin Qian, Xu Tang, Shenglan BMJ Open Epidemiology 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. BMJ Publishing Group 2015-11-13 /pmc/articles/PMC4654304/ /pubmed/26567254 http://dx.doi.org/10.1136/bmjopen-2015-008994 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ |
spellingShingle | Epidemiology Ji, Honglei Jiang, Hong Yang, Limin Qian, Xu Tang, Shenglan Factors contributing to the rapid rise of caesarean section: a prospective study of primiparous Chinese women in Shanghai |
title | Factors contributing to the rapid rise of caesarean section: a prospective study of primiparous Chinese women in Shanghai |
title_full | Factors contributing to the rapid rise of caesarean section: a prospective study of primiparous Chinese women in Shanghai |
title_fullStr | Factors contributing to the rapid rise of caesarean section: a prospective study of primiparous Chinese women in Shanghai |
title_full_unstemmed | Factors contributing to the rapid rise of caesarean section: a prospective study of primiparous Chinese women in Shanghai |
title_short | Factors contributing to the rapid rise of caesarean section: a prospective study of primiparous Chinese women in Shanghai |
title_sort | factors contributing to the rapid rise of caesarean section: a prospective study of primiparous chinese women in shanghai |
topic | Epidemiology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4654304/ https://www.ncbi.nlm.nih.gov/pubmed/26567254 http://dx.doi.org/10.1136/bmjopen-2015-008994 |
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