Factors associated with Chinese nulliparous women's choices of mode of delivery: A longitudinal study

Caesarean section rates have risen beyond the WHO recommended level in many countries worldwide. An emerging epidemic in caesareans has appeared in China over the past two decades, mainly driven by non-medical factors. China's one-child policy was previously seen as a potential factor for contributing to women's high caesarean section rates. The Chinese government has officially announced a two-child policy in recent years, causing numerous families to reshape their fertility intentions and birth preferences. There have been few studies focusing on women's expected and actual delivery mode and the associated factors affecting their choices of mode of delivery.

To investigate nulliparous women's expected and actual mode of delivery, and the related factors associated with delivery mode in the context of China's two-child policy.

This longitudinal study approached 1368 pregnant women who attended the antenatal clinic regularly at a tertiary specialized women's hospital in Shanghai, China. Among the 1368 women, 1211 agreed to participate and were investigated at admission of this study.

Data were collected via questionnaires using Birth Attitude Questionnaire (BAQ), Subjective Norm Questionnaire (SNQ), and Childbirth Self-Efficacy Scale (CSES). Descriptive statistics and logistic regression analyses were used.

Of 1211 participants, the number of women expecting a vaginal delivery at three pregnancy stages accounted for 74%, 78%, and 83%, respectively. Finally 48% (520/1084) ended up having a caesarean delivery. Caesarean section for lack of medical indications accounted for 57% (297/520). Among women who met the requirements of two-child policy, 39% planned to have a second child. In logistic regression analyses, participants with stronger expectations of caesarean deliveries during late pregnancy (aOR, 35.18; 95% CI, 12.66-97.74), having higher scores of birth attitude toward CS (aOR, 1.13; 95% CI, 1.06-1.20), and with lower scores of intrapartum childbirth self-efficacy (aOR, 0.85; 95% CI, 0.77-0.92) had significantly higher odds of having an actual caesarean delivery.

During the initial period of China's two-child policy, the majority of women value vaginal delivery whereas high caesarean section rate still becomes a great concern in current China. Individual preferences, birth attitude, and childbirth self-efficacy are altogether associated with women's different choices of mode of delivery.