title: Cesarean section in Shanghai: women's or healthcare provider's preferences?
abstract: BACKGROUND
  Cesarean section (CS) rate has increased rapidly over the past two decades in China mainly driven by non-medical factors. This study was to compare recalled preferences for CS among first-time mothers in early and late pregnancy with actual delivery mode; to explore factors related to CS preference and CS performed without medical indications; and to consider the role of healthcare providers in delivery mode preferences.
  
  
  METHODS
  An anonymous questionnaire survey, combined with data on CS indications taken from the patient record, was conducted among 272 first-time mothers having their first postnatal check-up in one university affiliated obstetrics and gynecology hospital in Shanghai, China, between September 2006 and January 2007. Logistic regression was used to study factors related to the recalled preference for CS and CS performed without medical indication, adjusting for maternal age, education and income.
  
  
  RESULTS
  The CS rate was 57% (151/263) among all women, 17% with medical indications and 40% without medical indications. For women without medical indications for CS (n = 215), there was no significant difference between women's preference for CS in early (25%) and late pregnancy (28%); 48% of women actually had CS. Women recalled preferring a vaginal delivery but who had CS were more likely to have had a CS suggested by a prenatal care doctor [OR (95% CI): 20 (3.88-107.1)] or by a delivery obstetrician [OR (95% CI): 26 (6.26-105.8)]. Among women recalled preferring and having CS, a suggestion from the prenatal care doctor to have CS was very common.
  
  
  CONCLUSIONS
  In the primiparous women without a medical indication for CS, women recall of a provider suggestion for CS was a strong predictor of CS both among women who recalled a preference for CS and among women who recalled a preference for vaginal delivery. Public health education needs strengthening, including discussion of the risks associated with CS and psychological and social support given to women to help them prepare for and cope with childbirth.
authors.forename: Wei
authors.initials: W
authors.lastname: Deng
authors.forename: Reija
authors.initials: R
authors.lastname: Klemetti
authors.forename: Qian
authors.initials: Q
authors.lastname: Long
authors.affiliation: School of Public Health, Fudan University, 138 Yi Xue Yuan Road, P,O, Box 250, Shanghai 200032, China. zcwu@shmu.edu.cn.
authors.forename: Zhuochun
authors.initials: Z
authors.lastname: Wu
authors.forename: Chenggang
authors.initials: C
authors.lastname: Duan
authors.forename: Wei-Hong
authors.initials: WH
authors.lastname: Zhang
authors.forename: Carine
authors.initials: C
authors.lastname: Ronsmans
authors.forename: Yu
authors.initials: Y
authors.lastname: Zhang
authors.forename: Elina
authors.initials: E
authors.lastname: Hemminki
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000523:psychology* / Q000706:statistics & numerical data*; D002681:China; D002755:Choice Behavior; D037001:Directive Counseling; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D010298:Parity; D057240:Patient Preference / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians'; D011247:Pregnancy; D011264:Pregnancy Trimesters; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult