Determinants of the choice of delivery mode in pregnant women: a convergent parallel mixed-methods study protocol

The mode of delivery is one of the most critical decisions in maternal care, influenced by psychological, social, cultural and medical factors. Despite the known benefits of vaginal delivery, the caesarean section rate (40%-55%) in Iran remains significantly higher than the WHO's recommended level (10%-15%). Fear of childbirth, anxiety, social norms and misinformation are among the key determinants shaping women's delivery preferences. Understanding these factors is essential for developing effective interventions to promote informed decision-making and reduce unnecessary caesarean sections. Thus, the study aims to assess the determinants of the choice of delivery mode in pregnant women.

This study will employ a convergent parallel mixed-methods design to comprehensively investigate the determinants of delivery mode choice among pregnant women. In the quantitative phase, a cross-sectional study will be conducted among 768 primigravid women attending health centres in Tabriz, Iran. Data will be collected using standardised instruments such as the Childbirth Fear Questionnaire, Depression, Anxiety and Stress Scale (DASS-21) and researcher-developed questionnaires addressing sociocultural, environmental and educational factors. Statistical analyses will include descriptive and inferential tests such as χ² and multivariate logistic regression. In the qualitative phase, semistructured interviews will be conducted with purposively selected participants to explore their experiences, beliefs and perceptions related to childbirth and delivery mode choice. Data will be analysed using conventional content analysis. The findings from both phases will be integrated during the interpretation stage to provide a comprehensive understanding of the phenomenon.

This study has received ethical approval from the Ethics Committee of Tabriz University of Medical Sciences, Tabriz, Iran (IR.TBZMED.REC.). Study findings will be disseminated through peer-reviewed journals and scientific conferences. The study started in August 2025 and will continue until 2027. A similar study design will be implemented in a national, multicentre setting during this period.