Purpose: Cesarean section rates in industrialized countries have steadily been rising since the 1970s. The aim of this study was to explore the association between delivery preferences during pregnancy and actual delivery mode.
Method: We combined data from the Norwegian Mother and Child Cohort Study and the Medical Birth Registry of Norway (n=66,351). At week 30 of pregnancy women were asked whether they preferred vaginal or cesarean delivery. We used delivery preferences, age, educational attainment, plurality (twin pregnancy) and a range of medical risk factors to explore predictors of the vaginal versus cesarean delivery by means of logistic regression analysis. Subsequently we predicted the probability of cesarean on the basis of the model’s parameter values.
Result: Among those with a cesarean preference (5% of the sample), 49% subsequently had a cesarean (13% acute and 36% elective), respectively 12% (9% acute and 3% elective) among those with a vaginal preference. In multivariate regressions, the odds for having an acute cesarean were higher among nulliparous (OR 1.99, 95% CI 1.41-2.81) and multiparous women (OR 2.76, CI 1.36-5.60) with a cesarean preference. For elective cesarean, the respective odds ratios were 12.48 (CI 9.60-16.24) and 9.42 (CI 4.34-20.48). Age, plurality, previous cesarean, breech position and various other medical conditions were also significant predictors. The predicted probability of acute or elective cesarean delivery for women without cesarean preference or medical risk factors for cesarean was 2% for nulliparous and 4% for multiparous. For women with a vaginal preference, but no risk factors the probabilities were 17% and 22%, respectively. When adding various medical risk factors, the probabilities were in the range of 60% to 90%.
Conclusion: Women’s preferences have a strong impact on the probability of an acute as well as elective cesarean even when adjusting for a range of medical factors.
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