Impact of first childbirth on changes in women's preference for mode of delivery: follow-up of a longitudinal observational study.
BACKGROUND
A woman's childbirth experience has an influence on her future preferred mode of delivery. This study aimed to identify determinants for women who changed from preferring a planned vaginal birth to an elective cesarean section after their first childbirth.


METHODS
This prospective longitudinal observational study involved two units that provide obstetric care in Hong Kong. A mail survey was sent to 259 women 6 months after their first childbirth. These women had participated in a longitudinal cohort study that examined their preference for elective cesarean section in the antenatal period of their first pregnancies. Univariate and multivariate analyses were performed to identify determinants for women who changed from preferring vaginal birth to elective cesarean section.


RESULTS
Twenty-four percent (23.8%, 95% CI 18.4-29.3) of women changed from preferring vaginal birth to elective cesarean section after their first childbirth. Determinants found to be positively associated with this change included actual delivery by elective cesarean section (OR 106.3, 95% CI 14.7-767.4) intrauterine growth restriction (OR 19.5, 95% CI 1.1-353.6), actual delivery by emergency cesarean section (OR 8.4, 95% CI 3.4-20.6), higher family income (OR 3.2, 95% CI 1.1-8.8), use of epidural analgesia (OR 2.6, 95% CI 1.0-6.8), and higher trait anxiety score (OR 1.1, 95% CI 1.0-1.3). The most important reason for women who changed from preferring vaginal birth to elective cesarean section was fear of vaginal birth (24.4%).


CONCLUSIONS
A significant proportion of women changed their preferred mode of delivery after their first childbirth. Apart from reducing the number of cesarean sections in nulliparous women, prompt provision of education to women who had complications and investigations into fear factors during vaginal birth might help in reducing women's wish to change to elective cesarean section.
Department of Obstetrics and Gynecology, Prince of Wales Hospital, Shatin, Hong Kong SAR.
Man Wah
MW
Pang
Tse Ngong
TN
Leung
Tze Kin
TK
Lau
Tony Kwok
TK
Hang Chung
D000328:Adult; D002585:Cesarean Section / Q000523:psychology* / Q000706:statistics & numerical data; D002755:Choice Behavior; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000379:methods* / Q000523:psychology*; D017558:Elective Surgical Procedures / Q000523:psychology / Q000706:statistics & numerical data; D005239:Fear; D005260:Female; D006723:Hong Kong; D006801:Humans; D008137:Longitudinal Studies; D015999:Multivariate Analysis; D007744:Obstetric Labor Complications / Q000523:psychology*; D016017:Odds Ratio; D010298:Parity; D036801:Parturition; D017060:Patient Satisfaction; D011247:Pregnancy; D037841:Pregnant People / Q000523:psychology*; D011446:Prospective Studies