ABSTRACT
Background:
Childbirth is a beautiful life event, a unique personal experience for each woman. The study aimed to assess the preferences and factors determining preference for mode of delivery among primigravida mothers.
Materials and Methods:
A descriptive exploratory design was applied to explore the factors for preferring the mode of delivery among 250 antenatal mothers, selected by convenient sampling technique. A self-structured dichotomous questionnaire on preference and factors influencing preference for mode of delivery was used. Descriptive and inferential statistical analysis was done using SPSS 20 software.
Results:
The majority of participants (98.4%) preferred vaginal delivery over elective cesarean section as a mode of delivery. The significant factor influencing preferences was speedy recovery after delivery (89.8%). However, significant factors for preferring the cesarean mode of delivery were the obstetrician’s advice and the baby’s safety (100%).
Conclusion:
The majority of women preferred a vaginal mode of delivery; they still undergo cesarean mode of delivery. Considering factors, there is a need to develop a positive attitude toward NVD and actions to create awareness toward a safe mode of delivery by building a mutual trust environment and increasing effective dissemination of correct and neutral delivery option advice.
Keywords: Cesarean section, mode of delivery, normal vaginal delivery, preferences, primigravida mothers
Introduction
Child birth well-known as labor or delivery is a beautiful life event which is personal and different for each woman.[1] During this period women have more concerns about their mode of delivery especially in the first delivery.[2] The mother’s right to choose the mode of delivery is an essential component of compassionate and respectful care in modern obstetrics.[3]
Naturally, vaginal birth has been regarded as the accepted mode of birth.[1] Cesarean section, which involves an operative incision, was introduced in clinical practice as a lifesaving procedure both for the mothers’ and infants’ life.[4]
According to the World Health Organization (WHO), the proportion of cesarean deliveries should remain between 10 and 15%.[5] The International Federation of Gynecology and Obstetrics states that cesarean should be performed for medical reasons only and not out of preference.[6]
In India the fifth National Family and Health Survey (NFHS) released by the Ministry of Health and Family Welfare on 24th November 2021 showed that the national cesarean section rate is 21.5%, which is higher than the WHO ideal rate, 10–15%.[7]
The limited literature on the delivery preferences of a representative sample of women in the state with an increasing rate of cesarean section motivated the researcher to perform the study. Researchers in her clinical experience also found that the study is essential to understand and explore the factors related to preferences and factors affecting the mode of delivery so that this knowledge can be implemented in nursing interventions and promote normal childbirth, thus reducing maternal and neonatal morbidity and mortality.
Search strategy
Strategy for searching relevant literature: Manual as well as Database and exploration engines, namely PubMED, SCOPUS, and Google Scholar were used to gather research studies of the past one decade, i.e., from 2010 to 2021 year, using specific keywords like cesarean section, factors for preference of a mode of delivery, mode of delivery, normal vaginal delivery, preferences, primigravida mothers. Other sources like websites such as Ministry of Health and Family Welfare sites, protocols, government data such as NFHS-5, grey literature were reviewed for further information.
Various types of research studies such as cross-sectional, cohort studies, descriptive qualitative studies, phenomenological qualitative studies, ethnographic, review article, mixed method, and systematic review were searched and incorporated in this chapter. Furthermore, an extensive and comprehensive review was done, eliminating duplicity.
Objectives
The objectives of the study were: (a) to find out the preferences for mode of delivery among primigravida mothers, (b) to describe various factors determining the preferences for a mode of delivery, (c) to find out the association between the preferences for mode of delivery and selected demographic variables, (d) to find out the association between the factors determining the preferences for vaginal mode of delivery and selected demographic variables, and (e) to find out the association between the factors determining the preferences for the cesarean mode of delivery and selected demographic variables
Study design
The “quantitative cross-sectional, descriptive design” was incorporated with, the primigravida mother’s preferred mode of delivery and factors affecting the preference for mode of delivery as the research variables The study was undertaken at antenatal OPD of AIIMS Bhopal, a medical research institution of national importance, located at Saket Nagar of Bhopal, Madhya Pradesh, India. Inclusion criteria were the married primigravida mother (a) between the age group of 20 and 45 years, (b) willing to participate in the study, and (c) can read and write and understand English or Hindi language. The exclusion criteria were the married primigravida mother who (a) cannot respond to the questionnaire like the mentally challenged, (b) not yet decided about the preferred mode of delivery, and (c) had medical indications for cesarean section.
The sample size was determined by using a single population proportion formula “n = [DEFF * N P (1 − p)]/[d2/Z2 1−α/2* (N-1) + p* (1 − p)]” assuming confidence level at 95%=1.96, a margin of error = 0.05, and proportion (p) = 20% of mothers prefer cesarean delivery according to the study conducted in Mangalore, India.[8] According to the formula, the sample size was calculated to be 243. Thus, 250 primigravida mothers were recruited for the study. A convenient sampling technique was adopted to recruit the potential participants, on the basis of the inclusion and exclusion criteria.
A self-structured questionnaire was used to collect information from primigravida mothers of age group between 20 and 45 years old on their preference for mode of birth and the factors that determined their preference. The tool developed consists of two parts: Part I and Part II.
Part I includes demographic variables which consist of 16 items to collect sample characteristics.
Part II consists of a structured questionnaire with a dichotomous scale that is divided into two sections. Section A: the factor that determines the preference for vaginal delivery mode of delivery Section B: the factor that determines the preference for cesarean mode of delivery.
S-CVI of part I was calculated to be 0.95, which is greater than 0.80; hence, the items of part I are valid. S-CVI of section A and section B of part II was calculated to be 0.86 and 0.87, respectively, which is greater than 0.80; hence, the items of section A and section B of part II are valid.
The questionnaire does not quantify any latent factor. Hence reliability checking is not applicable for the tool used in this study.
Ethics approval and consent to participate
Ethical approval was obtained from the Institutional Ethical Committee of AIIMS Bhopal on 3rd March 2021 [Ref Number of approval letter: 2020/MSc (Nursing)/July/08] prior to the commencement of the study. All eligible primigravida mothers were recruited on the basis of criteria. Potential participants were provided with a participant information sheet (in the language understandable to the participant) stating the purpose of the study, supplemented with an explanation if needed and written informed consent was obtained before the study.
Procedure of data collection
The data were collected in the following manner: Name list of the primigravida mothers attending antenatal OPD was taken from the OPD reception. Primigravida mothers sitting in the waiting area outside OPD were personally met. Participants fulfilling the inclusion criteria were recruited into the study by using a convenient sampling technique. Self-introduction and establishment of rapport with the subjects were done. Purposes of the study were explained and written consent from the subject was taken for participating in the study. Participants were ensured of anonymity and confidentiality of the information provided. Participants ready to join were enrolled in the study. Participants were made to sit in separate rooms near antenatal OPD, where they could concentrate and attempt the questionnaire. Two hundred fifty primigravida mothers were selected according to the study criteria. Part I of a self-structured questionnaire that contains demographic variables was administered to the subject. The subjects who have chosen normal vaginal delivery were given section A of part 2 to assess the factors that influenced their choice and those who have chosen cesarean section were given section B of part 2. Those who have not yet decided on the preferred mode of delivery, i.e., four primigravida mothers were excluded from the study
Results
Data analysis was done using Statistical Package for Social Studies (SPSS version 20).
Descriptive statistics were depicted using frequency and percentage, whereas inferential statistics included nonparametric Chi-square test and Fischer’s exact test.
The majority of participants 246 (98.4%) preferred normal vaginal delivery and only 4 (1.6%) preferred cesarean section as a mode of delivery. Demographic details of participants are depicted in Table 1, Table 2 describes factors determining the preference for vaginal mode of delivery, Table 3 describes factors determining the preference for cesarean mode of delivery, Table 4 depicts the association between the preferred mode of delivery and selected demographic variables, and Table 5 describes the association between factors determining the preference for vaginal mode of delivery and selected demographic variables.
Table 1.
Demographic variables of participants (n=249)
| Demographic Variables | Frequency (%) |
|---|---|
| Age in years | |
| 20–26 years | 140 (56) |
| 27–33 years | 107 (42.8) |
| 34–40 years | 3 (1.2) |
| 40–45 years | 0 |
| Residence | |
| Rural | 26 (10.4) |
| Urban | 224 (89.6) |
| Religion | |
| Christian | 6 (2.4) |
| Hindu | 233 (93.2) |
| Muslim | 10 (4.0) |
| Other | 1 (0.4) |
| Educational level (woman) | |
| Primary | 3 (1.2) |
| Secondary | 51 (20.4) |
| Graduate | 105 (42) |
| Postgraduate | 91 (36.4) |
| Educational level of the husband | |
| Cannot read and write | 3 (1.2) |
| Primary | 1 (0.4) |
| Secondary | 42 (16.8) |
| Graduate | 130 (52) |
| Postgraduate | 74 (29.6) |
| Employment status (woman) | |
| Government | 21 (8.4) |
| Private | 22 (8.8) |
| Self-employed | 6 (2.4) |
| Homemaker | 201 (80.4) |
| Employment status of husband | |
| Government | 53 (21.2) |
| Private | 142 (56.8) |
| Self-employed | 36 (14.4) |
| Other | 19 (7.6) |
| Type of family | |
| Joint family | 155 (62) |
| Nuclear family | 93 (37.2) |
| Other | 2 (0.8) |
| Woman’s occupation | |
| Nonhealth related | 227 (90.8) |
| Physician | 5 (2.0) |
| Nurse | 13 (5.2) |
| Allied health | 5 (2.0) |
| Monthly household income | |
| Below Rs. 5000 | 4 (1.6) |
| Rs. 5001–Rs. 15000 | 31 (12.4) |
| Rs. 15001–Rs. 25000 | 54 (21.6) |
| Rs. 25001–Rs. 35000 | 47 (18.8) |
| >Rs. 35001 | 114 (45.6) |
| Weeks of gestation | |
| 1–12 weeks | 58 (23.2) |
| 13–28 weeks | 87 (34.8) |
| 29–40 weeks | 105 (42) |
| Place preferred for delivery | |
| Government hospitals | 212 (84.8) |
| PHC | 1 (0.4) |
| CHC | 5 (2.0) |
| District hospital | 3 (1.2) |
| Employees of State Insurance hospital | 1 (0.4) |
| Maternity nursing homes/Birthing centers | 0 |
| Private hospitals | 10 (4.0) |
| Home delivery | 0 |
| Undecided | 18 (7.2) |
| Any medical illness found during pregnancy | |
| Hypertension | 11 (4.4) |
| Diabetes mellitus | 2 (0.8) |
| Anemia | 7 (2.8) |
| Others | 23 (9.2) |
| None | 207 (82.8) |
| Knowledge about the mode of delivery | |
| Family | 230 (92) |
| Friends | 9 (3.6) |
| Relatives | 3 (1.2) |
| Social media | 2 (0.8) |
| ANC classes | 3 (1.2) |
| Pregnancy apps | 3 (1.2) |
| Any adverse events faced in life that affect your thoughts about the birth process. | |
| Yes | 3 (1.2) |
| No | 247 (98.8) |
Table 2.
Factors determining the preference for vaginal mode of delivery (n=246)
| Variables | Frequency (%) | |
|---|---|---|
|
| ||
| Yes | No | |
| Maternal Physiological factors | ||
| I think there is provision for using natural pain relief measures during labor | 47 (19.1) | 199 (80.8) |
| I think there are no particular dietary restrictions in vaginal delivery as compared to cesarean | 99 (40.2) | 147 (59.7) |
| I believe recovery after vaginal delivery is sooner than cesarean delivery | 221 (89.8) | 25 (10.1) |
| I feel the pain will be less after vaginal delivery as compared to delivery after cesarean | 203 (82.5) | 43 (17.4) |
| I think after vaginal delivery scars will not be formed over the abdomen as in a cesarean section | 175 (71.1) | 71 (28.8) |
| I can regain my prepregnant body shape easily | 181 (73.6) | 65 (26.4) |
| I believe the risk for infection after delivery is less in vaginal delivery when compared to cesarean delivery | 183 (74.4) | 63 (25.6) |
| In my opinion, long-term complications are less after vaginal delivery | 194 (78.9) | 52 (21.1) |
| Baby’s factors | ||
| I can initiate breastfeeding earlier after vaginal delivery | 203 (82.5) | 43 (17.4) |
| Shortly after delivery, I can give better baby care and can, thus, increase the bonding between my baby and me | 218 (88.6) | 28 (11.3) |
| I believe the chances of newborn babies getting sickness are less in vaginal delivery | 141 (57.3) | 105 (42.6) |
| I feel there is a decreased likelihood of NICU admission with vaginal birth | 141 (57.3) | 105 (42.6) |
| Sociocultural factors | ||
| In my opinion, birth should be natural and traditional | 177 (72) | 69 (28.04) |
| I prefer vaginal delivery due to my partner’s or family pressure | 8 (3.3) | 238 (96.7) |
| I prefer vaginal delivery as my friends and family members had an unpleasant experience following cesarean section | 69 (28) | 177 (71.9) |
| I have read comments shared on social media, saying that vaginal delivery is the best mode of delivery | 86 (35) | 160 (65.04) |
| I have heard if once the cesarean is done, always the cesarean will be done in subsequent pregnancies, so I prefer vaginal delivery | 128 (52) | 118 (47.9) |
| I choose a vaginal mode of delivery as per the obstetrician’s advice | 15 (6.1) | 231 (93.9) |
| I think the duration of hospital stay is less after vaginal delivery than cesarean delivery | 117 (47.6) | 129 (52.4) |
| Financial factors | ||
| In my opinion, vaginal delivery is less expensive as compared to cesarean delivery | 60 (24.4) | 186 (75.6) |
Table 3.
Factors determining the preference for cesarean mode of delivery (n=4)
| Variables | Frequency (%) | |
|---|---|---|
|
| ||
| Yes | No | |
| Maternal Physiological Factor | ||
| I get relief from the prolonged painful delivery process | 3 (75) | 1 (25) |
| I can prevent injuries to my perineum and vagina | 2 (50) | 2 (50) |
| I choose cesarean as vagina gets loose after normal vaginal delivery. | 3 (75) | 1 (25) |
| In my opinion, problems with sexual life after cesarean section are less common | 2 (50) | 2 (50) |
| Maternal Psychological Factor | ||
| I can avoid uncomfortable or embarrassing position on the delivery table during vaginal delivery if delivery occurs through cesarean | 2 (50) | 2 (50) |
| I can overcome the fear of bleeding during vaginal delivery course | 2 (50) | 2 (50) |
| I prefer cesarean delivery as I do not want to get episiotomy (a surgical cut made at the opening of the vagina during childbirth) done | 2 (50) | 2 (50) |
| Baby’s Factor | ||
| I believe cesarean delivery as it ensures safe childbirth without any injury to the baby | 4 (100) | 0 |
| Socio- cultural Factor | ||
| I prefer cesarean delivery as it happens faster than vaginal birth | 3 (75) | 1 (25) |
| I consider cesarean delivery as a modern mode of delivery | 2 (50) | 2 (50) |
| I prefer cesarean delivery due to my partner’s or family pressure | 2 (50) | 2 (50) |
| In my opinion, planned cesarean sections are suitable as date and time can be selected | 3 (75) | 1 (25) |
| I can do tubal sterilization along with cesarean section | 3 (75) | 1 (25) |
| I feel less care is provided during labor process in normal vaginal delivery | 2 (50) | 2 (50) |
| I have read comments shared on social media, saying that cesarean is safer than normal vaginal delivery | 2 (50) | 2 (50) |
| I prefer cesarean delivery as my friends and family members had an unpleasant experience during vaginal delivery | 2 (50) | 2 (50) |
| I choose cesarean mode of delivery as per the obstetrician’s advice considering my or baby’s health. | 4 (100) | 0 |
| I feel this is my precious pregnancy and I do not want to take risk. | 3 (75) | 1 (25) |
Table 4.
Association between the preferred mode of delivery and selected demographic variables
| Demographic Variables | Preferred mode of delivery | FET | P | ||
|---|---|---|---|---|---|
|
| |||||
| NVD n=246 (%) | CS n=4 (%) | Total n (%) | |||
| Age in years | |||||
| 20–26 years | 138 (98.6) | 2 (1.4) | 140 (100) | 0.05 | 1.00 |
| 27–45 years | 108 (98.2) | 2 (1.8) | 110 (100) | ||
| Residence | |||||
| Rural | 25 (96.2) | 1 (3.8) | 26 (100) | 0.93 | 0.35 |
| Urban | 221 (98.7) | 3 (1.3) | 224 (100) | ||
| Educational level (woman) | |||||
| Up to higher secondary | 53 (98.1) | 1 (1.9) | 54 (100) | 0.02 | 1.00 |
| Graduation and above | 193 (98.5) | 3 (1.5) | 196 (100) | ||
| Educational level of the husband | |||||
| Up to higher secondary | 44 (97.8) | 1 (2.2) | 45 (100) | 0.13 | 1.00 |
| Graduation and above | 202 (98.5) | 3 (1.5) | 205 (100) | ||
| Type of family | |||||
| Joint family | 153 (98.1) | 3 (1.9) | 156 (100) | 0.27 | 0.667 |
| Nuclear family and other | 93 (98.9) | 1 (1.1) | 94 (100) | ||
| Monthly household income | |||||
| <Rs. 35000 | 135 (99.3) | 1 (0.7) | 136 (100) | 1.41 | 0.334 |
| >Rs. 35001 | 111 (97.4) | 3 (2.6) | 114 (100) | ||
| Any medical illness found during pregnancy | |||||
| Yes | 41 (95.3) | 2 (4.7) | 43 (100) | 3.07 | 0.138 |
| No | 205 (99) | 2 (1.0) | 207 (100) | ||
| Knowledge about the mode of delivery | |||||
| Family | 228 (98.7) | 3 (1.3) | 231 (100) | 1.75 | 0.273 |
| Other sources | 18 (94.7) | 1 (5.3) | 19 (100) | ||
Significant at P<0.05. FET=Fischer Exact Test
Table 5.
Association between factors determining the preference for a vaginal mode of delivery and selected demographic variables (n=246)
| Demographic variable Factors |
Age | Residence | Edu. Level (woman) | Edu. Level (Husband) | Employment status (Husband) | Type of family | Woman’s Occupation | Monthly Household income | Weeks of gestation | Medical illness found during pregnancy |
|---|---|---|---|---|---|---|---|---|---|---|
| Item 1 | 1.38 | 0.43 | 1.08 | 0.75 | 1.98 | 0.03 | 1.23 | 4.33 | 1.40 | 2.90 |
| 0.46 | 0.51 | 0.89 | 0.94 | 0.57 | 0.85 | 0.26 | 0.22 | 0.49 | 0.40 | |
| Item 2 | 2.76 | 4.51* | 5.18 | 3.66 | 10.5* | 0.40 | 2.08 | 2.10 | 0.13 | 4.71 |
| 0.25 | 0.03* | 0.26 | 0.45 | 0.03* | 0.52 | 0.14 | 0.55 | 0.93 | 0.19 | |
| Item 3 | 7.08 | 0.14 | 17.4* | 21.3* | 3.05 | 0.45 | 0.09 | 11.7* | 1.44 | 0.31 |
| 0.29 | 0.70 | 0.001* | 0.001* | 0.38 | 0.49 | 0.75 | 0.02* | 0.48 | 0.95 | |
| Item 4 | 0.61 | 0.82 | 6.74 | 8.75 | 9.44 | 7.90 | 3.96 | 3.28 | 2.73 | 4.36 |
| 0.73 | 0.36 | 0.15 | 0.06 | 0.21 | 0.5 | 0.41 | 0.35 | 0.25 | 0.22 | |
| Item 5 | 7.49* | 0.50 | 1.22 | 3.37 | 2.40 | 2.52 | 0.52 | 0.90 | 1.00 | 3.00 |
| 0.02* | 0.47 | 0.87 | 0.49 | 0.49 | 0.11 | 0.47 | 0.82 | 0.60 | 0.39 | |
| Item 6 | 2.95 | 0.03 | 7.22 | 8.07 | 10.62* | 0.89 | 2.53 | 1.17 | 4.49 | 1.41 |
| 0.22 | 0.85 | 0.12 | 0.4 | 0.03* | 0.34 | 0.11 | 0.76 | 0.10 | 0.70 | |
| Item 7 | 6.24* | 0.03 | 5.27 | 6.96 | 3.52 | 0.12 | 0.62 | 1.74 | 0.06 | 2.87 |
| 0.04* | 0.84 | 0.26 | 0.13 | 0.31 | 0.72 | 0.42 | 0.62 | 0.96 | 0.41 | |
| Item 8 | 9.59* | 0.13 | 9.82* | 9.41* | 2.70 | 0.02 | 0.43 | 1.17 | 0.27 | 1.41 |
| 0.01* | 0.71 | 0.04* | 0.05* | 0.44 | 0.96 | 0.51 | 0.76 | 0.87 | 0.70 | |
| Item 9 | 1.68 | 0.12 | 12.3* | 12.4* | 2.38 | 0.45 | 0.09 | 12.7* | 1.44 | 11.1* |
| 0.43 | 0.72 | 0.01* | 0.01* | 0.49 | 0.49 | 0.75 | 0.01* | 0.48 | 0.04* | |
| Item 10 | 0.61 | 0.82 | 14.3* | 16.8* | 9.44 | 7.69* | 3.96 | 18.4* | 2.73 | 4.36 |
| 0.73 | 0.36 | 0.01* | 0.01* | 0.21 | 0.05* | 0.41 | 0.01* | 0.25 | 0.22 | |
| Item 11 | 0.10 | 0.50 | 1.22 | 3.37 | 2.40 | 2.52 | 0.52 | 0.90 | 1.00 | 3.00 |
| 0.94 | 0.47 | 0.87 | 0.49 | 0.49 | 0.11 | 0.47 | 0.82 | 0.60 | 0.39 | |
| Item 12 | 2.95 | 0.03 | 7.22 | 8.07 | 3.52 | 0.89 | 2.53 | 1.17 | 4.49 | 1.41 |
| 0.22 | 0.85 | 0.12 | 0.4 | 0.31 | 0.34 | 0.11 | 0.76 | 0.10 | 0.70 | |
| Item 13 | 0.29 | 0.22 | 7.08 | 8.33 | 12.4* | 11.2* | 3.13 | 4.44 | 0.84 | 3.68 |
| 0.22 | 0.63 | 0.13 | 0.08 | 0.01* | 0.01* | 0.07 | 0.21 | 0.65 | 0.29 | |
| Item 14 | 1.23 | 6.76* | 5.38 | 3.77 | 31.3* | 0.89 | 0.09 | 5.45 | 1.44 | 0.31 |
| 0.54 | 0.01* | 0.25 | 0.43 | 0.01* | 0.34 | 0.75 | 0.14 | 0.48 | 0.95 | |
| Item 15 | 1.84 | 0.21 | 2.89 | 2.39 | 9.35 | 0.03 | 0.88 | 6.07 | 0.78 | 3.28 |
| 0.39 | 0.64 | 0.57 | 0.66 | 0.06 | 0.85 | 0.34 | 0.10 | 0.67 | 0.35 | |
| Item 16 | 0.12 | 0.59 | 3.17 | 5.93 | 5.86 | 0.20 | 1.04 | 4.53 | 7.4* | 3.04 |
| 0.94 | 0.44 | 0.52 | 0.20 | 0.11 | 0.65 | 0.30 | 0.20 | 0.02* | 0.38 | |
| Item 17 | 0.47 | 0.17 | 2.81 | 6.0 | 6.93 | 0.20 | 1.04 | 0.53 | 0.94 | 3.04 |
| 0.78 | 0.67 | 0.58 | 0.19 | 0.07 | 0.65 | 0.30 | 0.91 | 0.62 | 3.42 | |
| Item 18 | 3.82 | 4.76* | 4.3 | 3.65 | 0.83 | 0.02 | 0.14 | 1.44 | 2.90 | 0.49 |
| 0.14 | 0.02* | 0.35 | 0.45 | 0.84 | 0.86 | 0.69 | 0.69 | 0.23 | 0.92 | |
| Item 19 | 3.15 | 0.22 | 4.09 | 1.93 | 7.22 | 0.10 | 10.7* | 0.90 | 6.26 | 3.00 |
| 0.20 | 0.63 | 0.39 | 0.38 | 0.06 | 0.75 | 0.01* | 0.82 | 0.4 | 0.39 | |
| Item 20 | 3.04 | 2.03 | 3.88 | 6.92 | 5.22 | 0.12 | 1.73 | 1.45 | 1.05 | 2.05 |
| 0.21 | 0.15 | 0.42 | 0.14 | 0.15 | 0.72 | 0.18 | 0.69 | 0.58 | 0.56 |
*Significant P<0.05
Table 4 reveals the Fischer’s exact test values computed between the preferred mode of delivery and selected demographic variables at P value less than 0.05. No significant association was found between the preferred mode of delivery with any of the above-selected demographic variable.
Table 5 shows Chi-square/Fischer’s exact test value computed and a significant association was found between certain factors affecting the preference for vaginal mode of delivery and selected demographic variables at P value less than 0.05.
Association between the factors affecting the preference for cesarean mode of delivery and selected demographic variable
As the primigravida mothers who preferred cesarean delivery was less than 5, inferential statistics like Chi-square and Fischer’s exact test cannot be computed to find out the association between the factors affecting the preference for cesarean mode of delivery and selected demographic variable.
Discussion
In the current study, majority of the primigravida mothers indicated their preference for vaginal delivery over cesarean delivery. Among the 250 participants, 246 (98.4%) preferred normal vaginal delivery and only 4 (1.6%) preferred cesarean section as a mode of delivery as depicted in [Figure 1]. Similarly, in another Indian study, out of 150 antenatal mothers, 120 (80%) preferred normal vaginal delivery and only 30 (20%) preferred cesarean delivery.[8]
Figure 1.
Preferred mode of delivery
In a study conducted in Kolar, India, out of 3,639 deliveries, 1,877 (52%) delivered vaginally and 1,762 (48%) delivered through cesarean section. Among the cesarean deliveries, 44 (2.5%) had maternal request as their indication.[9] It shows that maternal request has a significant contribution to the rise in cesarean section rate in India.
The major factors for preferring normal vaginal delivery by the respondents in the present study were speedy recovery after vaginal delivery (89.8%), can give better baby care, and can increase the bonding between the baby and mother (88.6%). Only 24.4% of primigravida mothers preferred the normal vaginal mode of delivery because they consider it economical. These findings were comparable with the result of a similar study conducted in Mangalore, India in which the major factors for preferring normal vaginal delivery among antenatal mothers were to avoid unnecessary surgical wound pain (100%), get speedy recovery from the postpartum period (100%), and to give birth by natural process (100%).[8]
There were certain studies that identified the factors that determined the women’s preference for vaginal mode of delivery other than the ones mentioned in the present study such as the possibility of surgery and anesthetic drugs passing to the baby during cesarean delivery.[10]
The major factors for preferring the cesarean mode of delivery in the current study are the obstetrician’s advice and for the safety of their baby (100%). These results are consistent with a study conducted in Hong Kong Chinese women aged between 18 and 45 years where the factors which influenced the mothers to choose cesarean delivery were baby’s factors such as the health of the newborn and maternal factors such as advanced age for childbirth, as labor pain is more in vaginal delivery, fear of perineal tear, risk of anal/urinary incontinence due to vaginal delivery, choosing an auspicious date and timing of the delivery, better planning for maternity and paternity leave.[1]
There were some studies which identified the factors that determined the women’s preference for cesarean mode of delivery other than the ones mentioned in the present study, like the advice from professionals such as physicians and midwives is an important influence on women in their choice of mode of birth, especially for cesarean delivery.[1,11,12] The images that doctors create for pregnant women about labor and vaginal delivery and its consequences encourage them to hesitate to do vaginal delivery.
In the present study, no significant association was found between preferences of mode of delivery of primigravida mothers with any of the selected demographic variables.
On contrary, in an Indian study, a significant association was established between the preferred modes of delivery with the antenatal mother’s plan of pregnancy.[8]
Another study conducted in Hong Kong reported that there was a statistically significant association between the preferred mode of delivery and age of women (P = 0.008), level of education (P = 0.016), and women’s occupation (P = 0.016).[1]
Conclusion
The results of the current study provide a better understanding of the preference and the factors influencing the preference of mode of delivery among childbearing women in Central India. Considering the dynamics of childbirth preference would certainly help obstetricians, midwives, and policymakers in the development of valuable interventions or management.
Although in the current study a vast majority of participants preferred NVD as their planned mode of delivery, there are still few who prefer elective cesarean section without any underlying medical indication. Many researchers have conveyed that elective cesarean section has increased alarmingly and has developed a trend. As per the findings of factors determining the preferences for cesarean mode of delivery, the obstetricians or midwives can consider these factors while educating or counseling the women to undergo normal vaginal delivery. The researchers in the present study strongly consider that actions have to be carried out to create awareness toward a safe mode of delivery by building a doctor–patient mutual trust environment and increasing effective dissemination of correct and neutral delivery option advice. There is a need for comprehensive evidence on the benefits and severity of the different modes of delivery, instead of just the birth processes. The findings from the study might be used in evidence-based midwifery practices in developing countries to encourage normal vaginal delivery and to increase the maternal health index.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
Acknowledgements
The authors would like to express profound gratitude to AIIMS Bhopal for giving us the support needed to undertake the study. The authors would also like to thank all participants who inspired us to put forth our best, without whose cooperation, the study would not have completed.
References
- 1.Loke AY, Davies L, Li SF. Factors influencing the decision that women make on their mode of delivery: The Health Belief Model. BMC Health Serv Res. 2015;15:274. doi: 10.1186/s12913-015-0931-z. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Süzer Özkan F, Demi?rc N. Factors Affecting Delivery Preference of Primigravida Women: A Qualitative Study. Turkiye Klinikleri Journal of Nursing Sciences. 2018;10:103–14. [Google Scholar]
- 3.Welay FT, Gebresilassie B, Asefa GG, Mengesha MB. Delivery Mode Preference and Associated Factors among Pregnant Mothers in Harar Regional State, Eastern Ethiopia: A Cross-Sectional Study. Mshana SE, editor. BioMed Research International. 2021;2021:1–7. doi: 10.1155/2021/1751578. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Zamani-Alavijeh F, Araban M, Hassanzadeh A, Makhouli K. Contributing factors of pregnant women's beliefs towards mode of delivery: A cross-sectional study from Iran. Matern Health Neonatol Perinatol. 2018;4:9. doi: 10.1186/s40748-018-0077-1. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.WHO | WHO statement on caesarean section rates [Internet]. WHO. [[Last accessed on 2021 Aug 24]]. Available from: http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/cs-statement/en/
- 6.Kosan Z, Kavuncuoglu D, Calıkoglu EO, Aras A. Delivery preferences of pregnant women: Do not underestimate the effect of friends and relatives. J Gynecol Obstet Hum Reprod. 2019;48:395–400. doi: 10.1016/j.jogoh.2019.03.009. [DOI] [PubMed] [Google Scholar]
- 7.National Family Health Survey (NFHS-5) [[Last accessed on 2021 Dec 11]]. Available from: http://rchiips.org/nfhs/factsheet_NFHS-5.shtml .
- 8.Shruthi Moolya, Rodrigues S, S SR. Preference for Normal Vaginal Delivery or Elective Caesarean Section Delivery and Factors Influencing it among Antenatal Mothers in Selected Hospital at Mangalore. International Journal of Health Sciences and Research. 2018;8:189–95. [Google Scholar]
- 9.Narayanaswamy M, Ambika B, Sruthi T. Cesarean delivery at maternal request in a rural medical college hospital. J Clin Gynecol Obstet. 2016;5:64–7. [Google Scholar]
- 10.Dursun P, Yanik FB, Zeyneloglu HB, Baser E, Kuscu E, Ayhan A. Why women request cesarean section without medical indication? J Matern Fetal Neonatal Med. 2011;24:1133–7. doi: 10.3109/14767058.2010.531327. [DOI] [PubMed] [Google Scholar]
- 11.Zhang H, Wu J, Norris J, Guo L, Hu Y. Predictors of preference for caesarean delivery among pregnant women in Beijing. J Int Med Res. 2017;45:798–807. doi: 10.1177/0300060517696217. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12.Sharghi Afshan, Kamran Aziz, Gholamreza S. Assessing the factors influencing delivery method selection in primiparous pregnant women referred to health centers in Ardabil. Iran Med J Hormozghan. 2011;15:234–42. [Google Scholar]