title: Influencing factors associated with the mode of birth among childbearing women in Hunan Province: a cross-sectional study in China.
abstract: An unnecessary Caesarean section (CS) can cause increased maternal and perinatal morbidity and other adverse short- and long-term outcomes. However, countries worldwide have witnessed an increasing trend toward the use of CS. Our objectives were to explore the influencing factors associated with the mode of birth among childbearing women in Hunan Province and to provide evidence and suggestions for the improvement and further understanding of vaginal birth (VB) in China.
  
  
  
  A total of 977 childbearing women (375 pregnant women and 602 mothers of infants) were enrolled in this study using a two-stage cluster sampling method, and a self-administered questionnaire was used to collect data relating to the mode of birth. A t-test and χ (2)-test were used to analyse the differences between groups, and logistic regression analysis was used to explore the factors that influenced the mode of birth.
  
  
  
  The VB ratio was 46.2 %, while the CS ratio was 53.8 % in Hunan Province. Among women whose preference was VB, only 69.4 % gave birth by VB. Among women whose preference was CS, 98.1 % gave birth by CS. The top four reasons for preferring CS were a lack of confidence in VB (37.3 %), an abnormality in the prenatal examination (36.6 %), the notion that the baby would suffer fewer risks (34.8 %) and the fear of pain from VB (32.7 %). Age, prenatal examination, and doctors' suggestion were significantly associated with women's mode of birth preference, while place of household registration, husband's preference, prenatal examination and doctors' suggestion had a significant influence on women who changed their choice from VB to CS.
  
  
  
  The percentage of CS in Hunan was extremely high. Medical factors, such as abnormalities in prenatal examinations, and non-medical factors, such as a lack of confidence in VB, the fear of pain during VB, the desire to select the time of birth and healthy birth systems, should be seriously considered. Targeted health promotion interventions should be implemented to improve the performance of VB.
authors.affiliation: Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, 100191, China.
authors.forename: Yuhui
authors.initials: Y
authors.lastname: Shi
authors.affiliation: Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, 100191, China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Jiang
authors.affiliation: Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, 100191, China.
authors.forename: Qingqi
authors.initials: Q
authors.lastname: Zeng
authors.affiliation: Chinese Center for Disease control and Prevention, Beijing, 102206, China.
authors.forename: Yanfei
authors.initials: Y
authors.lastname: Yuan
authors.affiliation: Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, 100191, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Yin
authors.affiliation: Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, 100191, China. changchun@bjmu.edu.cn.
authors.forename: Chun
authors.initials: C
authors.lastname: Chang
authors.affiliation: Maternal and Child Health Care of China Association, Beijing, 100080, China.
authors.forename: Ruyan
authors.initials: R
authors.lastname: Pang
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000523:psychology* / Q000706:statistics & numerical data; D016009:Chi-Square Distribution; D002681:China; D002755:Choice Behavior; D016000:Cluster Analysis; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000523:psychology* / Q000706:statistics & numerical data; D005239:Fear / Q000523:psychology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008423:Maternal Age; D008875:Middle Aged; D009035:Mothers / Q000523:psychology*; D007744:Obstetric Labor Complications / Q000523:psychology; D036801:Parturition / Q000523:psychology; D057240:Patient Preference; D011247:Pregnancy; D037841:Pregnant People / Q000523:psychology*; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Caesarean section; China; Health promotion; Mode of birth; Vaginal birth