Psychosocial Factors for Women Requesting Cesarean Section

Yajuan Zhao, Shuangyun Chen

Department of Obstetric and Gynecology, Taihe Hospital, Hubei Medical College, Shiyan, China;.
Department of Obstetric and Gynecology, Taihe Hospital, Yunyang Medical College, Shiyan, China..

DOI: 10.4236/ijcm.2013.49071                

Abstract

Background: Rates of caesarean section are progressively increasing in many parts of the world. As a result of psychosocial factors, there has been an increasing tendency for pregnant women without justifiable medical indications for caesarean section to ask for this procedure in China. The psychosocial factors for requesting cesarean section were analyzed in our study. Methods: A self-made questionnaire and the State-Trait Anxiety Inventory (STAI) and Self-rating Depression Scale (SDS) were administered to evaluate lying-in women’s psychosocial state. Results: The proportion of lying-on women’s age and education degree was different significantly between the two groups (p < 0.01). In the study groups, the proportion of lying-on women who were in lower economic degree and in her first para was markerly higher than control (88.62% vs. 63.24%; 13.32％ vs. 3.42%, p < 0.01). In the study groups, the proportion of women who felt fearful, anxious, depressed and lacking confidence was higher than control. The ratio of women with university education in the CS group was higher than vaginal delivery group. The proportion of lying-on women without correct delivery knowledge was higher than control, but the difference was not significant (p > 0.05). By logistic regression, we found that for primipara, higher education degree, anxiety and lacking confidence were the dangerous factors for cesarean, while lower economic degree was a defendant factor. Conclusion: There were five main psychosocial factors such as education degree and economic state, parity, anxiety and confidence of lying-on women affecting the choice of the delivery way. The nulliparous women who feel anxious without confidence in nice economic state, with better education have higher risk to choose cesarean.

Keywords

Cesarean Section; Psychosocial Factor; Delivery Mode; Anxiety; Depression

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	WHO, “Monitoring Emergency Obstetric Care: A Handbook,” WHO, Geneva, 2009.
[2]	WHO, “Indicators to Monitor Maternal Health Goals,” WHO, Geneva, 1994.
[3]	A. P. Betrán, M. Merialdi, J. A. Lauer, W. Bing-Shun, J. Thomas, P. Van Look and M. Wagner, “Rates of Caesarean Section: Analysis of Global, Regional and National Estimates,” Paediatric and Perinatal Epidemiology, Vol. 21, No. 2, 2007, pp. 98-113. doi:10.1111/j.1365-3016.2007.00786.x
[4]	T. Duan, “Present Situation and Some Thoughts of Caesarean Section,” Chinese Journal of Practical Gynecology and Obstetrics, Vol. 24, No. 10, 2008, pp. 721-723.
[5]	M. R. Festin, M. Laopaiboon, P. Pattanittum, M. R. Ewens, D. J. Henderson-Smart, C. A. Crowther and SEAOR-CHID Study Group, “Caesarean Section in Four South East Asian Countries: Reasons for, Rates, Associated Care Practices and Health Outcomes,” BMC Pregnancy Childbirth, Vol. 9, 2009, p. 17. doi:10.1186/1471-2393-9-17
[6]	P. Lumbiganon, M. Laopaiboon, A. M. Gülmezoglu, J. P. Souza, S. Taneepanichskul, P. Ruyan, D. E. Attygalle, N. Shrestha, R. Mori, D. H. Nguyen, T. B. Hoang, T. Rathavy, K. Chuyun, K. Cheang, M. Festin, V. Udomprasertgul, M. J. Germar, G. Yanqiu, M. Roy, G. Carroli, K. Ba-Thike, E. Filatova and J. Villar, “World Health Organization Global Survey on Maternal and Perinatal Health Research Group: Method of Delivery and Pregnancy Outcomes in Asia: The WHO Global Survey on Maternal and Perinatal Health 2007-2008,” Lancet, Vol. 375, No. 9713, 2010, pp. 490-499. doi:10.1016/S0140-6736(09)61870-5
[7]	S. L. Tang, X. Y. Li and Z. C. Wu, “Rising Caesarean Delivery Rate in Primiparous Women in Urban China: Evidence from Three Nationwide Household Health Surveys,” American Journal of Obstetrics & Gynecology, Vol. 195, No. 6, 2006, pp. 1527-1532. doi:10.1016/j.ajog.2006.03.044
[8]	A. Li and Y. Lan, “Pregnant Women’s Mental Health Status of 2,523 Cases Investigated,” China Practical Gynecologic and Obstetric, Vol. 19, No. 1, 2003, p. 32.
[9]	L.-Y. Kuo, B. Q. White and W. Long, “Maternal Psychological Status and the Relationship between Mode of Delivery,” China Practical Gynecologic and Obstetric Magazine, Vol. 17, No. 5, 2001, p. 2814.
[10]	I. Wiklund, G. Edman and E. Andolf, “Cesarean on Maternal Request: Reson for the Request, Self-Estimated Health, Expectations, Experience of Birth and Signs of Depression among First-Time Mothers,” Acta Obstetricia et Gynecologica Scandinavica, Vol. 86, No. 4, 2007, pp. 451-456. doi:10.1080/00016340701217913
[11]	I. Hilldingsson, I. Radestad, C. Rupertsson, et al., “Few Women wish Tobe Delivered by Caesarean Section,” BJOG: An International Journal of Obstetrics & Gynaecolog, Vol. 109, No. 6, 2002, pp. 618-623. doi:10.1111/j.1471-0528.2002.01393.x
[12]	World Health Organization, “Appropriate Technology for Birth,” Lancet, Vol. 2, No. 8452, 1985, pp. 436-437.
[13]	B. S. Wang, L. F. Zhou, L. Zhu, X. L. Gao and E. S. Gao, “Maternal Preference of Delivery Mode and the Causes,” Maternal and Child Health Care of China, Vol. 20, No. 22, 2005, pp. 2920-2924.
[14]	M. W. Pang, T. N. Leung, T. K. Lau and T. K. Hang Chung, “Impact of First Childbirth on Changes in Women’s Preference for Mode of Delivery: Follow-Up of a Longitudinal Observational Study,” Birth, Vol. 35, No. 2, 2008, pp. 121128. doi:10.1111/j.1523-536X.2008.00225.x
[15]	B. A. Bettes, V. H. Coleman, S. Zinberg, et al., “Cesarean Delivery on Maternal Request: Obstetrician-Gynecologists’ Knowledge, Perception, and Practice Patterns,” Obstetrics and Gynecology, Vol. 109, No. 1, 2007, pp. 57-66. doi:10.1097/01.AOG.0000249608.11864.b6
[16]	S. J. Robson, W. S. Tan, A. Adeyemi and K. B. G. Dear, “Estimating the Rate of Cesarean Section by Maternal Request: Anonymous Survey of Obstetricians in Australia,” Birth, Vol. 36, No. 3, 2009, pp. 208-212. doi:10.1111/j.1523-536X.2009.00331.x
[17]	T. Nilstun, M. Habiba, G. Lingman, R. Saracci, M. Da Frè and M. Cuttini, “Cesarean Delivery on Maternal Request: Can the Ethical Problem Be Solved by the Principlist Approach?” BMC Medical Ethics, Vol. 9, 2008, p. 11. doi:10.1186/1472-6939-9-11
[18]	S. R. Miesnik and B. J. Reale, “A Review of Issues Surrounding Medically Elective Cesarean Delivery,” JOGNN, Vol. 36, No. 6, 2007, pp. 605-615. doi:10.1111/j.1552-6909.2007.00196.x
[19]	H. Amark and E. L. Ryding, “Women Wishig Tobe Delivered by Cesarean section. Anxiety, Risk-Thing and Shame Common According to A Qualitative Study,” Lakartidningen, Vol. 104, No. 12, 2007, pp. 950-953.
[20]	L. Anderson, I. Sundstom-Poroma, M. Bixo, et al., “Piont Prevalence of Psychiatric Disorders during the Second Trimester of Pregnancy: A Population Based Study,” American Journal of Obstetrics & Gynecology, Vol. 189, No. 1, 2003, pp. 148-154. doi:10.1067/mob.[phone]
[21]	I. Wiklund, G. Edman and E. Andolf, “Personality and Mode of Delivery,” Acta Obstetricia et Gynecologica Scandinavica, Vol. 85, No. 10, 2006, pp. 1225-1230. doi:10.1080/00016340600839833
[22]	I. Siklund, G. Edman, C. Larsson, et al., “Personality and Mode of Delivery,” Acta Obstetricia et Gynecologica Scandinavica, Vol. 85, No. 10, 2006, pp. 1225-1230.
[23]	T. Kitamaru, A. Ahima, M. Augawara, et al., “Psychosocial Correlates of Antennal Depression,” Psychotherapy and Psychosomatics, Vol. 65, 1998, pp. 117-123. doi:10.1159/000289062
[24]	A. O. Ilesanmi, O. Fawole, D. O. Olaleye and A. Arowojolu, “Pregnancy Outcome in the Elderly Primigravidae,” Journal of Obstetrics and Gynaecology, Vol. 18, No. 1, 1998, pp. 40-43. doi:10.1080/01443619868253
[25]	M. Carolan, “The Project: Having a Baby over 35 Years,” Women and Birth, Vol. 20, No. 3, 2007, pp. 121-126. doi:10.1016/j.wombi.2007.05.004
[26]	R. Lampinen, K. Vehvilainen-Julkunen and P. Kankkunen, “A Review of Pregnancy in Women over 35 Years of Age,” Open Nursing Journal, Vol. 3, 2009, pp. 33-38. doi:10.2174/1874434600903010033