Identifying factors contributing to health workers' preferences for elective caesarean section: a qualitative study

Caesarean section (CS) rates continue to increase worldwide, driven by multiple factors. This qualitative study explored how health workers, as maternity clients choosing their own mode of childbirth, understood the factors influencing their preference for elective CS.

This qualitative descriptive study used conventional content analysis. Between October 2023 and May 2024, we purposively recruited 24 health workers affiliated with Qom University of Medical Sciences from teaching hospitals, primary healthcare centres, and university academic departments. Eligible participants had undergone an elective caesarean section for their own childbirth within the previous two years. Data were collected through in-depth, face-to-face, semi-structured interviews in Persian and analysed in MAXQDA 18 using the approach described by Graneheim and Lundman.

Analysis of the 24 interviews generated 120 initial codes, two themes, five categories, and 14 subcategories. Health workers' preference for elective caesarean section was shaped by fears and concerns related to labour and vaginal birth, including fear of labour pain, concerns about maternal and newborn safety, anticipated loss of privacy and dignity, and negative perceptions of vaginal birth. Practical considerations, particularly the predictability of caesarean section for managing timing, work, and family responsibilities, also contributed to decision-making. Health-system conditions included limited confidence in the availability of labour pain relief, restrictions on labour companionship, concerns about staff behaviour and competence, and easier access to caesarean section through professional familiarity with specialists.

These context-specific findings point to potential areas for maternity-service improvement, including strengthening respectful maternity care, improving reliable access to labour pain relief, protecting privacy and dignity during labour, and reviewing institutional practices that may shape negative expectations of vaginal birth among health workers as maternity clients.