Choice of Delivery in Tehran and Some Related Factors
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Abstract
Objective: This study assessed the influence of maternal request on elective cesarean rate and related factors in maternity hospitals in Tehran.
Materials and Method: This cross sectional descriptive analytic study was performed via a two-step random sampling technique, using data from 824 pregnant women who attended the maternity hospitals in Tehran in 2001. A questionnaire covering past and present obstetrical history and demographic characteristics was completed for each mother. SPSS software was used for data analysis. Descriptive analysis and inference tests, including chi-square and t-tests were used. Logistic regression test was also used to find the correlation between variables. P value less than 0.05 was considered for statistical significance.
Results: Totally 66.5% of mothers underwent cesarean and 33.5% had normal vaginal delivery. From cesarean cases 72% were elective and of these 22% were done upon maternal request. It was shown that 71% of mothers who selected cesarean had no scientific reason. Also, 65% of doctors suggested cesarean for their patients without any true medical indication. The majority of elective cesareans performed on maternal request were done in private hospitals (86% in private vs. 14% in public hospitals) (P<0.0001). High educational , employment status and first pregnancy significantly increase the demand for cesarean section.
Conclusion: Increasing the level of awareness and attitude of mothers and providing painless normal vaginal delivery as well as vaginal delivery after previous cesarean, the frequency of unnecessary cesareans and related complications can be decreased.
World Health Organization. Appropriate Technology for Birth. Lancet 1985; 436-7.
Hale R. Operative delivery In: Current Obstetric & Gynecologic. 8th Edition. U.S.A: Appleton & Lange, 1999.
Paterson- BrownS. Should doctors perform an elective caesarean section on request? Yes, as long as the women is fully informed. BMJ 1998; 317(7156): 462- 463.
Scott J. Cesarean delivery in: Danforth’s Obstetrics & Gynecology. 8th Edition. U.S.A: Lippincott Williams & Wilkins, 1999.
Wiklund I, Edman G, Andolf .Cesarean section on maternal request: reasons for the request, self-estimated health, expectations, experience of birth and signs of depression among first-time mothers. Acta Obstetrics & Gynecology Scandinavia 2007;86(4):451-456.
Amu O, Rajendran S, Boloji II. Should doctors perform an elective caesarean section on request? Maternal choice alone should not determine method of delivery. BMJ 1998; 317 (7156): 463- 465.
Norman B, Crowhurst JA, Plaat F. Elective cesarean on request.All types of anesthesia carry risks. BMJ 1999; 318(7176): 120.
Quadros LGA. Brazilian obstetricians are pressured to perform cesarean sections. BMJ 2000; 320: 1073–1074.
Francome C, Savage W, Churchill H and Lewison H. Cesarean Birth in Britain. 1st Edition. London: Middles university Press, 1993.
NIH State-of-the-Science Conference Statement on cesarean delivery on maternal request.NIH Consens State Sci Statements 2006 Mar 27-29;23(1):1-29.
Ferriman A. Cesarean section rate hits 20% in 1999-2000. British Medical Journal 2001; 322 : 1508 (letters).
Garmaroodi G. Prevalence of CS and some predisposing factors in primigravida women in maternity delivery units in Tehran in 1999. Maternal and Child Health Publication of Jahad University of Tehran University of Medical Sciences, 2000.
Larijani B. Prevalence of CS in Tehran in 1996. Research Report of Endocrinology Research Center , Tehran University of Medical Sciences,1996.
Johnson SR, Elkins TE, Phelan JP.Obstetric decision making: responses to patients who request cesarean delivery. Obstetrics and Gynecology 1986; 67 (6): 847 – 850.
Jackson NV, Irvine LM. The influence of maternal request on the elective cesarean section rate. Journal of Obstetric and Gynecology 1998;18:115-19.
Eftekhar K. Women choose caesarean section. British Medical Journal 2000;320(7241): 1073.
Belzian JM, Althabe F, Burros FC. Rates and implications of cesarean sections in Latin America :ecological study. BMJ. 1999; 319(7222): 1397 –400.
Murray SF. Relation between private health insurance and high rates of cesarean section in Chile: qualitative and qualitative study. British Medical Journal 2000; 321: 1501 – 1505.
Dobson R. Cesarean section rate in England and Wales hits 21. BMJ 2001; 323(7319) : 951.
Al- Mufti R, Mccartly A, Fisk NM. Survey of obstetrician’s personal preference and discretionary practice. European Journal of obstetric, Gynecology, Reproduction and Biology 1997; 73 : 1-4.
Nurttall Ch. The cesarean culture of Brazil. British Medical Journal 2000; 320(7241): 1074..
Lowdermilk D, Perry SE, Bobak IM. Labor and birth complications in: Maternity and women’s health care. 7th Edition. U.S.A: Mosby Com, 2000.
Zulueta PD. Elective cesarean section on request patients do not have right to impose their wishes at all cost. British Medical Journal 1999; 321: 120 (letters).
Fisher J, Smith A, Astbary J. Private health insurance and a healthy personality: new risk factor for obstetric intervention. Journal of Psychosom Obstet Gynaecol 1995; 16(1) : 1-9.
Strirat GM, Dunn PM. Elective cesarean sections on request. Obstetricians are more than technicians. BMJ 1999; 318(7176): 120- 121.
| Files | ||
| Issue | Vol 1, No 2 (December 2007) | |
| Section | Original Articles | |
| Keywords | ||
| Cesarean Elective cesarean Maternal request | ||
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