Attitudes, Perceptions and Determinants of Non-Medically Indicated Caesarean Section Preference Among Pregnant Women...

Non-medically indicated caesarean section (CS) is a growing contributor to rising CS rates globally and in Thailand, influenced by maternal preference, socio-cultural factors and clinical decision-making. Understanding women's perspectives is essential to guide counselling strategies and inform policy targeted at reducing unnecessary CS.

To explore pregnant women's attitudes, perceptions and determinants of preference for non-medically indicated CS and identify factors associated with CS preference.

This prospective, descriptive, three-phase mixed-methods study was conducted from May 1 to July 30, 2024. The study was conducted at an antenatal clinic. The study comprised three phases: in-depth interviews with 40 pregnant women, questionnaire development and validation, and a survey of 400 participants. Descriptive statistics summarised had demographic data, while univariable chi-squared tests and multivariable logistic regression analysed factors associated with non-medically indicated CSs. Odds ratios and 95% confidence intervals (CIs) were reported, with statistical significance set at P < 0.05. The main outcomes and measures were the attitudes, perceptions, policy, implementation science, counselling frameworks, and clinician-patient power dynamics of pregnant women towards non-medically indicated caesarean sections.

Among the 400 women surveyed, 75% preferred vaginal delivery as a more natural and less risky option. However, 60% 60% reported they would still agree to a CS if recommended by a doctor, indicating high reliance on physician guidance even in situations without clear medical indication. Key factors affecting delivery preferences included prior caesarean delivery (adjusted odds ratio 2.5, 95% CI 1.5‒4.0) and maternal age over 35 years (adjusted odds ratio 1.8, 95% CI 1.1‒2.9). Comprehensive counselling was deemed essential by 80% of participants, who reported greater confidence in choosing vaginal delivery after thorough discussions of risks and benefits. Auspicious timing influenced 39.5%, while 37.3% were swayed by pain perception. Higher education levels, assisted conception methods and concerns about safety, such as blood loss, also shaped CS preferences.

Pregnant women in Thailand generally prefer vaginal birth but are highly influenced by physician recommendations. Strengthening counselling, addressing misconceptions and incorporating shared decision-making into routine antenatal care may reduce non-indicated CS demand. Findings support future development of counselling frameworks and policy interventions to promote safe, evidence-based delivery choices.

TCTR 20230913007: Date of registration 13 September 2023.