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Open Access Research

Preferences for mode of delivery in nulliparous Argentinean women: a qualitative study

Nancy H Liu1, Agustina Mazzoni2*, Nina Zamberlin3, Mercedes Colomar4, Olivia H Chang5, Lila Arnaud6, Fernando Althabe2 and José M Belizán2

Author Affiliations

1 Department of Psychiatry-SFGH, University of California, San Francisco, Suite 7M. 1001 Potrero Avenue, San Francisco, CA, 94110, USA

2 Institute for Clinical Effectiveness and Health Policy (IECS), Dr. Emilio Ravignani 2024. C1414CPV, Buenos Aires, Argentina

3 Center for the Study of State and Society (CEDES), Sanchez de Bustamante 27. C1173AAA, Buenos Aires, Argentina

4 Clinical and Epidemiological Research Unit (UNICEM), Hospital de Clinicas, Avda. Italia s/n, Montevideo, Uruguay

5 Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, Louisiana, 70112, USA

6 Tulane University School of Public Health and Tropical Medicine, 1440 Canal St, New Orleans, LA, 70112, USA

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Reproductive Health 2013, 10:2  doi:10.1186/1742-4755-10-2

Published: 14 January 2013

Abstract

Background

Over the last three decades, cesarean section (CS) rates have been rising around the world despite no associated improvement in maternal and perinatal mortality and morbidity. The role of women’s preferences for mode of delivery in contributing to the high CS rate remains controversial; however these preferences are difficult to assess, as they are influenced by culture, knowledge of risk and benefits, and personal and social factors. In this qualitative study, our objective was to understand women’s preferences and motivational factors for mode of delivery. This information will inform the development and design of an assessment aimed at understanding the role of the women’s preferences for mode of delivery.

Methods

We conducted 4 focus group discussions (FGDs) and 12 in-depth interviews with pregnant women in Buenos Aires, Argentina in 4 large non-public and public hospitals. Our sample included 29 nulliparous pregnant women aged 18–35 years old, with single pregnancies over 32 weeks of gestational age, without pregnancies resulting from assisted fertility, without known pre-existing medical illness or diseases diagnosed during pregnancy, without an indication of elective cesarean section, and who are not health professionals. FGDs and interviews followed a pre-designed guide based on the health belief model and social cognitive theory of health decisions and behaviors.

Results

Most of the women preferred vaginal delivery (VD) due to cultural, personal, and social factors. VD was viewed as normal, healthy, and a natural rite of passage from womanhood to motherhood. Pain associated with vaginal delivery was viewed positively. In contrast, women viewed CS as a medical decision and often deferred decisions to medical staff in the presence of medical indication.

Conclusions

These findings converge with quantitative and qualitative studies showing that women prefer towards VD for various cultural, personal and social reasons. Actual CS rates appear to diverge from women’s preferences and reasons are discussed.

Keywords:
Cesarean section; Women’s preferences; Mode of delivery; Qualitative