title: Women's preferences and mode of delivery in public and private hospitals: a prospective cohort study.
abstract: BACKGROUND
  Rates of caesarean section have steadily increased in most middle- and high-income countries over the last few decades without medical justification. Maternal request is one of the frequently cited non-medical factors contributing to this trend. The objectives of this study were to assess pregnant women's preferences regarding mode of delivery and to compare actual caesarean section rates in the public and private sectors.
  
  
  METHODS
  A prospective cohort study was conducted in two public and three private hospitals in Buenos Aires, Argentina. 382 nulliparous pregnant women (183 from the private sector and 199 from the public sector) aged 18 to 35 years, with single pregnancies over 32 weeks of gestational age were enrolled during antenatal care visits between October 2010 and September 2011. We excluded women with pregnancies resulting from assisted fertility, women with known pre-existing major diseases or, with pregnancy complications, or with a medical indication of elective cesarean section. We used two different approaches to assess women's preferences: a survey using a tailored questionnaire, and a discrete choice experiment.
  
  
  RESULTS
  Only 8 and 6% of the healthy nulliparous women in the public and private sectors, respectively, expressed a preference for caesarean section. Fear of pain and safety were the most frequently expressed reasons for preferring caesarean section. When reasons for delivery mode were assessed by a discrete choice experiment, women placed the most emphasis on sex after childbirth. Of women who expressed their preference for vaginal delivery, 34 and 40% ended their pregnancies by caesarean section in public and private hospitals, respectively.
  
  
  CONCLUSIONS
  The preference for caesarean section is low among healthy nulliparous women in Buenos Aires. The reasons why these women had a rate of more than 35% caesarean sections are unlikely related to their preferences for mode of delivery.
authors: Mother and Child's Health Research Department, Institute for Clinical Effectiveness and Health Policy (IECS), Dr. Emilio Ravignani 2024, C1414CPV, Buenos Aires, Argentina. amazzoni@iecs.org.ar.
authors: Agustina
authors: A
authors: Mazzoni
authors: Mother and Child's Health Research Department, Institute for Clinical Effectiveness and Health Policy (IECS), Dr. Emilio Ravignani 2024, C1414CPV, Buenos Aires, Argentina.
authors: Fernando
authors: F
authors: Althabe
authors: Institute for Clinical Effectiveness and Health Policy (IECS), Dr. Emilio Ravignani 2024, C1414CPV, Buenos Aires, Argentina.
authors: Laura
authors: L
authors: Gutierrez
authors: Institute for Clinical Effectiveness and Health Policy (IECS), Dr. Emilio Ravignani 2024, C1414CPV, Buenos Aires, Argentina.
authors: Luz
authors: L
authors: Gibbons
authors: UCSF General Internal Medicine, 3333 California Street, Box 0856, San Francisco, CA, 94118, USA.
authors: Nancy H
authors: NH
authors: Liu
authors: Maternal and Child Health Program, Ministry of Health, 483 1/2 7th Avenue, 1900, La Plata, Buenos Aires Province, Argentina.
authors: Ana María
authors: AM
authors: Bonotti
authors: Department of Obstetrics, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1181ACH, Buenos Aires, Buenos Aires, Argentina.
authors: Gustavo H
authors: GH
authors: Izbizky
authors: Obstetrics Unit, Hospital Magdalena V. de Martínez, Avenida Constituyentes 395, General Pacheco, Tigre, 1617, Buenos Aires Province, Argentina.
authors: Marta
authors: M
authors: Ferrary
authors: Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno" (CEMIC), Hospital Universitario Saavedra, Av. Galván 4102, 1431FWO, Buenos Aires, Argentina.
authors: Nora
authors: N
authors: Viergue
authors: Obstetrics Unit, Hospital Británico de Buenos Aires, Perdriel 74, C1280AEB, Buenos Aires, Argentina.
authors: Silvia I
authors: SI
authors: Vigil
authors: Obstetrics Unit, Hospital Materno Infantil Dr. Carlos Gianantonio, Diego Palma 505, San Isidro, Buenos Aires Province, Argentina.
authors: Gabriela
authors: G
authors: Zalazar Denett
authors: Mother and Child's Health Research Department, Institute for Clinical Effectiveness and Health Policy (IECS), Dr. Emilio Ravignani 2024, C1414CPV, Buenos Aires, Argentina.
authors: José M
authors: JM
authors: Belizán
mesh_terms: D000293:Adolescent; D000328:Adult; D001118:Argentina; D002585:Cesarean Section / Q000523:psychology; D002755:Choice Behavior; D036861:Delivery, Obstetric / Q000379:methods / Q000523:psychology*; D005239:Fear; D005260:Female; D016304:Hospitals, Private / Q000706:statistics & numerical data*; D006779:Hospitals, Public / Q000706:statistics & numerical data*; D006801:Humans; D010146:Pain / Q000523:psychology; D010298:Parity; D036801:Parturition / Q000523:psychology; D057240:Patient Preference; D011247:Pregnancy; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D055815:Young Adult