Preference for cesarean section in young nulligravid women in eight OECD countries and implications for reproductive health education

摘要

Background: Efforts to reduce unnecessary Cesarean sections (CS) in high and middle income countries have focusedudon changing hospital cultures and policies, care provider attitudes and behaviors, and increasing women’s knowledgeudabout the benefits of vaginal birth. These strategies have been largely ineffective. Despite evidence that women haveudwell-developed preferences for mode of delivery prior to conceiving their first child, few studies and no interventionsudhave targeted the next generation of maternity care consumers. The objectives of the study were to identify howudmany women prefer Cesarean section in a hypothetical healthy pregnancy, why they prefer CS and whether womenudreport knowledge gaps about pregnancy and childbirth that can inform educational interventions.udMethods: Data was collected via an online survey at colleges and universities in 8 OECD countries (Australia, Canada,udChile, England, Germany, Iceland, New Zealand, United States) in 2014/2015. Childless young men and womenudbetween 18 and 40 years of age who planned to have at least one child in the future were eligible to participate. Theudcurrent analysis is focused on the attitudes of women (n = 3616); rates of CS preference across countries are compared,udusing a standardized cohort of women aged 18–25 years, who were born in the survey country and did not studyudhealth sciences (n = 1390).udResults: One in ten young women in our study preferred CS, ranging from 7.6% in Iceland to 18.4% in Australia. Fearudof uncontrollable labor pain and fear of physical damage were primary reasons for preferring a CS. Both fear ofudchildbirth and preferences for CS declined as the level of confidence in women’s knowledge of pregnancy and birthudincreased.udConclusion: Education sessions delivered online, through social media, and face-to-face using drama and stories toldudby peers (young women who have recently had babies) or celebrities could be designed to maximize young women’sudcapacity to understand the physiology of labor and birth, and the range of methods available to support them inudcoping with labor pain and to minimize invasive procedures, therefore reducing fear of pain, bodily damage, and lossudof control. The most efficacious designs and content for such education for young women and girls remains to beudtested in future studies.