Does attendance of a prenatal education course reduce rates of caesarean section on maternal request? A questionnaire study in a tertiary women hospital in Shanghai, China

OBJECTIVE: Caesarean section rates have significantly increased worldwide. China has a caesarean rate of 46%, with a moderate contribution of caesarean section on maternal request. In this study, we investigated the association between maternal characteristics, attendance at a prenatal education course and caesarean section on maternal request. DESIGN: Questionnaire study. SETTING: Tertiary hospital in China. SAMPLE: 564 questionnaires. METHODS: On postpartum day 42, questionnaire data were collected. Data including age, parity, gravida, delivery mode, educational level, residence status, living condition and attendance of prenatal education course were analysed. PRIMARY AND SECONDARY OUTCOME MEASURES: Factors associated with caesarean section on maternal request. RESULTS: 46% of women were delivered by caesarean section on maternal request. Maternal age and residence status were all significantly associated with having a caesarean section on maternal request. The OR of an increase in caesarean section on maternal request in women over 30 years was 2.42 (95%confidence limits 1.597 to 3.666), compared with women under 30 years. 75% more women who resided in Shanghai had caesarean section on maternal request, compared with women who resided outside of Shanghai. However, there was a significant reduction (35%) in the number of caesarean sections on maternal request in women who attended a prenatal education course (p=0.029). There was no significant association between attendance of a prenatal education course and the other maternal characteristics studied. CONCLUSION: Maternal age is associated with an increased risk of caesarean section on maternal request. For women of all age, attendance of a prenatal education course significantly reduced the rate of caesarean section on maternal request. Our data suggest that promotion of a prenatal education course is an important tool in China to reduce the rate of caesarean section.