239296 Maternal request cesarean section: How often does this occur?

Monday, October 31, 2011: 8:30 AM

Kristen Kjerulff, MA, PhD , Public Health Sciences, Penn State University College of Medicine, Hershey, PA
Diana Velott, MPA, MS , Department of Public Health Sciences, Penn State Hershey College of Medicine, Hershey, PA
Junjia Zhu, PhD , Department of Public Health Sciences, Penn State Hershey College of Medicine, Hershey, PA
Carol S. Weisman, PhD , Department of Health Evaluation Sciences, Pennsylvania State College of Medicine, Hershey, PA
Marianne M. Hillemeier, PhD, MPH , Health Policy and Administration, The Pennsylvania State University, University Park, PA
John Repke, MD , Obstetrics and Gynecology, College of Medicine, Penn State University, Hershey, PA
Background: The cesarean section (CS) rate has increased rapidly in recent years in the US. This increase has been attributed in part to increasing numbers of women requesting CS in order to be able to avoid labor, choose a convenient date for delivery, or for other reasons. However, little research has measured how often women specifically request CS, either prior to or during labor. Methods: More than 3,000 women age 18 to 35 who were expecting their first child in Pennsylvania in 2009 to early 2011 were interviewed after 34 weeks gestation and one month after delivery to measure mode of delivery preferences and requests. Results: In the pre-delivery interview 94.0% indicated that they would prefer to deliver vaginally, 3.0% preferred CS and 3.0% had no preference. Overall, 70.6% delivered vaginally, 5.1% had planned CS (scheduled to occur prior to onset of labor) and 24.3% had unplanned CS. Only one study participant reported requesting a planned CS, and 3.7% reported requesting CS during labor. Among those who preferred vaginal delivery 28.0% delivered by CS, among those with no preference 44.4% did, and among those who preferred CS 59.2% did. The participant who requested a planned CS did have one, and among the women who requested CS during labor 45.3% did. Conclusions: Although explicit maternal request of planned CS prior to first delivery appears to be rare, women's preferences and requests as to mode of delivery do appear to influence whether they deliver by CS.

Learning Areas:
Clinical medicine applied in public health
Public health or related education
Public health or related nursing
Public health or related research
Social and behavioral sciences

Learning Objectives:
1. List five factors that affect women’s mode of delivery preferences prior to first delivery. 2. Describe the procedure for measuring women’s attitudes toward cesarean delivery. 3. Articulate six characteristics of labor that can affect the mode of first delivery.

Keywords: Maternal Care, Reproductive Health Research

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been conducting research in women's health for more than 25 years, have been a professor for more than 30 years and am principal investigator of the study on which I am presenting
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.