title: Cesarean section on maternal request: reasons for the request, self-estimated health, expectations, experience of birth and signs of depression among first-time mothers.
abstract: OBJECTIVE
  The purpose of this study was to investigate first-time mothers undergoing cesarean section in the absence of medical indication, their reason for the request, self-estimated health, experience of delivery, and duration of breastfeeding. We also aimed to study if signs of depression postpartum are more common in this group.
  
  
  METHODS
  In a prospective cohort study 357 healthy primiparas from two different groups, "cesarean section on maternal request" (n=91) and "controls planning a vaginal delivery" (n=266) completed three self-assessment questionnaires in late pregnancy, two days after delivery and 3 months after birth. Symptom scores from the Edinburgh postnatal depression scale at three months after birth were also investigated.
  
  
  RESULTS
  Women requesting cesarean section experienced their health ass less good (p<0.001) and were more often planning for one child only (p<0.001). They more often reported anxiety for lack of support during labor (p<0.001), for loss of control (p<0.001), and concern for fetal injury/death (p<0.001). After planned cesarean section women in this group reported a better birth experience compared to women planning a vaginal birth (p<0.001). They were breastfeeding to a lesser extent three months after birth (p<0.001). There were no differences in signs of postpartum depression between the groups three months after birth (p=0.878).
  
  
  CONCLUSIONS
  The knowledge gained from this study may help in understanding why some women prefer to give birth with elective cesarean section. It also elucidates the need for awareness of professional support during vaginal birth.
authors.affiliation: Division of Obstetrics and Gynecology, Karolinska Institutet, Stockholm, Sweden. ingela.wiklund@bb.ptj.se
authors.forename: Ingela
authors.initials: I
authors.lastname: Wiklund
authors.forename: Gunnar
authors.initials: G
authors.lastname: Edman
authors.forename: Ellika
authors.initials: E
authors.lastname: Andolf
mesh_terms: D000328:Adult; D001007:Anxiety / Q000453:epidemiology; D001942:Breast Feeding / Q000453:epidemiology / Q000523:psychology; D002585:Cesarean Section / Q000523:psychology*; D015331:Cohort Studies; D019052:Depression, Postpartum / Q000453:epidemiology* / Q000523:psychology; D017558:Elective Surgical Procedures / Q000523:psychology*; D005260:Female; D006304:Health Status; D006801:Humans; D007743:Labor, Obstetric / Q000523:psychology*; D010298:Parity; D017060:Patient Satisfaction; D011247:Pregnancy; D011446:Prospective Studies; D012649:Self Concept; D012944:Social Support; D013548:Sweden / Q000453:epidemiology