title: Factors associated with caesarean sections in Phnom Penh, Cambodia.
abstract: C-sections are an increasingly performed medical practice which can save lives but may also lead to major complications. Through a mixed methods study conducted in 2015 in Cambodia, we aimed to analyze the reasons for requesting a c-section and to explore factors that are associated with c-sections. 60% of the women in the cohort who gave birth by c-section reported having requested it. Through 31 in-depth interviews, we determined the reasons given by women for requesting a c-section before and during labour. Before labour, reasons for requesting a c-section were: choosing the delivery date; bringing luck and joy to the family; protecting the genitals, and the belief that c-section is safer for the mother and for the baby. Reasons given during labour were fear, pain, and having no more energy. We also observed two major factors driving the women's request for a c-section: family support for requesting a c-section, and the over-usage of ultrasound examinations. Our multivariate analysis of the interviews of 143 women before and after delivery showed that having a previous c-section, delivering in a private facility, being older than median at the time of sexual debut, residing outside of Phnom Penh and having the delivery costs covered by the family were all factors independently and significantly associated with a higher chance of c-section delivery. We conclude that women are not well informed to give consent for c-delivery, and that their request is often affected by false belief and poor knowledge.
authors.affiliation: Midwife-PhD, Centre Population et Développement (Ceped), UMR 196: IRD (Institut de Recherche pour le Développement), Paris France. Electronic address: clemschantz@hotmail.com.
authors.forename: Clémence
authors.initials: C
authors.lastname: Schantz
authors.affiliation: Obstetrician, Calmette Maternity Hospital, Phnom Penh, Cambodia.
authors.forename: Kruy Leang
authors.initials: KL
authors.lastname: Sim
authors.affiliation: Professor of Demography, Université Paris Descartes, Paris, France.
authors.forename: Véronique
authors.initials: V
authors.lastname: Petit
authors.affiliation: Obstetrician, Calmette Maternity Hospital, Phnom Penh, Cambodia.
authors.forename: Heng
authors.initials: H
authors.lastname: Rany
authors.affiliation: Midwife-PhD, Independent researcher, Annecy-le-Vieux, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Goyet
mesh_terms: D000328:Adult; D002160:Cambodia; D002585:Cesarean Section / Q000523:psychology* / Q000706:statistics & numerical data; D003657:Decision Making; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D008880:Midwifery; D009035:Mothers / Q000523:psychology*; D015999:Multivariate Analysis; D009774:Obstetrics; D011247:Pregnancy; D011446:Prospective Studies; D055815:Young Adult
keywords: Cambodia; caesarean section; gender; mixed method; overbiomedicalization; social control