title: Cultural perceptions and preferences of Iranian women regarding cesarean delivery.
abstract: BACKGROUND
  Data was reported in Iran in 2013 has shown that almost 42 percent of deliveries in public hospitals and 90 percent in private hospitals were carried out with cesarean section. This high rate of cesarean requires careful consideration. It seems that making decision for cesarean is done under the influence of cultural perceptions and beliefs. So, this study was conducted to explore pregnant women's preferences and perceptions regarding cesarean delivery.
  
  
  METHODS
  A focused ethnographic study was used. 12 pregnant women and 10 delivered women, seven midwives, seven gynecologist and nine non-pregnant women referred to the health clinics of Tonekabon, who selected purposively, were included in the study. To collect data semi-structured in-depth interviews and participant observation were used. Study rigor was confirmed through prolonged engagement, member check, expert debriefing, and thick description of the data. Data were analysed using thematic analysis and MAXQDA software.
  
  
  RESULTS
  Four themes emerged from the data including personal beliefs, fear of vaginal delivery, cultural norms and values and also social network. These concepts played main roles in how women develop meanings toward caesarean, which affected their perceptions and preferences in relation to caesarean delivery.
  
  
  CONCLUSIONS
  Most of pregnant women believed that fear of vaginal delivery is a major factor to choose caesarean delivery. Hence, midwives and physicians could help them through improving the quality of prenatal care and giving them positive perception towards vaginal delivery through presenting useful information about the nature of different modes of delivery, and their advantages and disadvantages, as well as the alternative ways to control labor pain.
authors.affiliation: Research Center for Patient Safety, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Robab
authors.initials: R
authors.lastname: Latifnejad-Roudsari
authors.affiliation: Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Maryam
authors.initials: M
authors.lastname: Zakerihamidi
authors.affiliation: Iranian National Center of Addiction Studies, (INCAS), Institution of Risk Behaviour Reduction, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Effat
authors.initials: E
authors.lastname: Merghati-Khoei
authors.affiliation: Department of Biostatistics, School of Medicine, Tarbiat Modares University, Tehran, Iran.
authors.forename: Anoshirvan
authors.initials: A
authors.lastname: Kazemnejad
keywords: Cesarean delivery; decision-making; focused ethnography; qualitative study