Publication:

Maternal request caesarean sections: fear tops the list

Background The increasing demand for caesarean delivery on maternal request (CDMR) is adding to the increasing caesarean rates worldwide. Pregnant women and families choose a CDMR for several reasons that include social, economic, and cultural contexts. This study was done in a south Indian state to explore the common local reasons for CDMR, as a first step to reduce this trend.

Methods Prospective observational, semi structured interview-based study of women who had chosen CDMR. Women with multifetal pregnancy and with previous caesarean sections were excluded. The primary outcomes were the reasons to choose a caesarean section over vaginal birth. The reasons were collected and divided into three themes: social and cultural, emotional reasons and personal previous experiences.

Results Ninety-two women gave consent to participate in the study and were interviewed. The most common reason to choose a caesarean in the absence of any medical indication was ‘fear’ of harm to the mother or baby, trauma, or vaginal examinations by 65 out of 92 women (70.65%). Theme of social influence was quoted as the reason by seven (7.6%) and previous personal experience with birth outcomes was cited by three women (3.2%).  The majority chose CDMR in the antenatal period even before they set into labour.

Conclusions Fear was the most common reason for choosing a CDMR, representing a misconception that caesarean birth is a safer, better alternative for the woman and her family. There is a need for change in discussions around antenatal care options, exploration of fears, and support systems to make a better-informed choice.