The Preferences of Modes of Child Delivery and Associated

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Introduction

Cesarean birth is associated with short- and long-term risks that can extend many years beyond the current delivery and affect the health of the woman, the child, and future pregnancies, in addition to exposing families to incur substantial healthcare costs.1 It may also cause serious health complications, disability, and even death, especially when it is undertaken in settings where the necessary medical facilities are lacking.2 In addition, cesarean section is associated with significantly increased odds of maternal intensive care unit admission, maternal near miss, and neonatal intensive care unit admission.3 According to Berhan and Haileamlak4 the relative risk of perinatal mortality and morbidity was about 2–5-fold higher in planned vaginal than in planned cesarean delivery. Furthermore, Adane et al5 found a high prevalence of surgical site infection among women who had undergone cesarean section in Ethiopia. Above all, Regan et al6 found that patients who undergo repeated cesarean section delivery are less likely to initiate breastfeeding compared to women who delivered by vagina and those that delivered by cesarean section after an unsuccessful trial of labor.

On the other hand, the underuse or inability of using cesarean section may also contribute to maternal and perinatal mortality and morbidity and may lead to postpartum hemorrhaging, reduced fertility and placental complications in subsequent pregnancies for mothers.7,8 In addition, failure to use cesarean section when it is necessary would make women to lose the opportunity of reduced risk of urinary incontinence, which is a common postpartum problem.9 Accordingly, it is suggested that cesarean section must be undertaken only when it is medically necessary and normal delivery is impossible or when a vaginal delivery would put the baby’s or mother’s life or health in danger, as stipulated by Tenaw et al.10 Consequently, Sayiner et al11 recommend encouraging members of the society to give birth by vaginal delivery with the aim of decreasing the cesarean section delivery rate, which is an important intervention due to its implications both on women’s health and the economy at large. And no doubt that such interventions should be backed by the findings of empirical researchabout whether pregnant women in a particular socio-cultural and economic context prefer normal or cesarean modes of delivery, including the factors determining such choices.

Roudsari et al12 contended that social, religious, and cultural beliefs significantly affect individuals’ attitudes towards modes of delivery, their definitions of these modes, and the choices they make. In addition, the study of Shi et al8 has shown that abnormalities in prenatal examinations, lack of confidence in vaginal birth, fear of pain during vaginal birth, and the desire to select time of birth and health birth systems influence the choice of cesarean section. Above all, old age, urban residential background, being from the richest social class, higher educational status, employment on a better occupational status, higher utilization of antenatal care, delivering babies at private hospitals, having pregnancy complications, being overweight and obese, antenatal care by doctors, twin delivery, having babies of high weight, the lack of companionship, the hospital’s private financing for performing delivery, being a first-time pregnant woman, history of abortus in the previous delivery, the number of living children, the fear of normal birth, doctor’s demand, and thinking cesarean section as healthier were found to be the factors positively associated with cesarean section.11,13–17 In contrast, Wang et al18 concluded that, compared with women in early pregnancy, women at the late stage of pregnancy were less likely to have an intended cesarean section delivery in China. Above all, Konlan et al19 revealed a significant positive correlation between average monthly income, the number of times of having cesarean section, considering cesarean section as safe for mother and baby, the belief that it is a pain-free method of delivery, friends’ advice, and religious advice have been the reasons for choosing cesarean section among women.

Though women, especially the urbanites, the higher class, the educated, and private care attendants, are increasingly choosing cesarean section, the literature suggests that this changing situation portrays only part of the reality as far decisions as about the mode of delivery are concerned. Accordingly, there are studies which reveal that women still prefer a normal mode of delivery due to various reasons. For instance, Liu et al20 found that most Argentinean women preferred vaginal delivery due to cultural, personal, and social factors. Most importantly, they indicated that women in their study positively viewed pain associated with vaginal delivery, and cesarean section was treated as a medical decision in which some women have deviated from the decisions of medical staff even in the presence of medical conditions. According to the findings of Kasai et al,21 most women in Brazil expressed a preference for vaginal birth, in the belief that vaginal delivery involves less suffering, better recovery, less risk, is quicker and, hence, allows earlier discharge from healthcare facilities, and is better for the wellbeing of both the mother and her babies. Furthermore, women who believed normal birth to be healthier, it’s being spontaneous in hospital, wish to get better soon, and having low economic status preferred normal delivery, according to the findings of Sayiner et al.11 It is therefore persuasive to argue that there are changes across space, over time, and among groups of societies regarding women’s decisions about the mode of delivery. These changes are unlikely, however, to explain the large increases and wide variations in cesarean section rates across countries.1 This, therefore, would justify the importance of undertaking further studies to uncover cultural and social context related factors associated with women’s increasing preference of cesarean section mode of child delivery.

Yaya et al22 found greater disparities in the prevalence rate of cesarean section among women of different countries in Sub-Saharan Africa. Moreover, findings from the analysis of a series of data collected for Ethiopian demographic and health survey23 revealed that the national prevalence rate of CS in Ethiopia is 2% and this prevalence rate significantly varies between geographical regions and among women of diverse socio-economic statuses. This calls for the need to undertake further studies to uncover the implication of socio-cultural variations in explaining differences in the rate of cesarean section and women’s preferences on the mode of delivery. Above all, studies of the effects of cultural issues on women’s decisions about delivery mode can contribute to the formulation of policies to confront problems associated with cesarean section.12 The purpose of the present research was therefore, to identify the preference of the mode of delivery among women attending antenatal care in Shashemene town, Southern Ethiopia.

Methods

Study Design

Using a quantitative research approach, an institutional-based cross-sectional study was undertaken in which data were collected from a sample of pregnant women attending antenatal care services in Southern Ethiopia. With both descriptive and explanatory study designs, we have assessed pregnant women’s preference of the mode of delivery, including the factors associated with their choices.

Methods and Procedures of Data Collection

Quantitative data were collected using a survey research method through distributing a structured questionnaire to a sample of pregnant women who have been attending antenatal healthcare services during the period of data collection. The questionnaire was developed first in English and later translated to the local language of the community where the data were collected. Then, it was given to two language editors who teach at Dilla University. Following that we have pilot tested the questionnaire taking 10% of the total sample size to ensure the validity of the instrument. Four nurses working in mother and child care departments of selected private and public healthcare facilities in Shashemene town were recruited. In addition, two enumerators trained in sociology were also employed for data collection. Then, training was given to both the nurses and the sociologists regarding the purpose and rationale of undertaking the research, the contents of the questionnaire, and ways of administering it.

A cooperation letter was secured from the concerned body of Senabor College and Dilla University. After determining the sampling procedure and sample size, the data collectors contacted the research participant in the respective healthcare facilities where they attend antenatal care services. In order to maintain the quality of data, selected pregnant women were briefly oriented about the research, their role in the process, the content and themes of the questionnaire, and how they are supposed to answer the questions. Moreover, the investigators of the research were closely attending the data collection activities and responding to the potential needs for clarification and related concerns.

Instrument Design

Few items of the questionnaire used to collect data for this study were taken and adopted to the context of the present research from the studies of Alabdullah et al17 and Welay et al,24 both of which are published in the form of open access articles. Most items of the questionnaire, however, were prepared by the authors of the present study in the way they can address the research question set out at the beginning. The questionnaire mainly consisted of two sections: a section containing variables intended to measure the socio-demographic characteristics of respondents and a section which measures their preferences of mode of deliveries. Accordingly, the first section contained variables such as age, religion, residential background, educational status, marital status, self-rated social class status, number of children, pregnancy experience, previous mode of delivery, and medical diagnosis reports about the health situation of the fetus. The second section of the questionnaire consisted of questions mainly aimed at measuring respondents’ choice of the mode of delivery and contained, among others, questions such as: 1) Have you ever been planning about your mode of delivery? 2) If yes, by which mode are you planning to deliver your baby? 3) If you are given the freedom to decide alone, which mode of delivery do you prefer? 4) Have you ever heard about cesarean section? 5) Do you have a close friend or family member who has delivered by CS? 6) Do you have full freedom to decide about your mode of delivery? 7) In your opinion, which method has less complications for the mother? 8) In your opinion, which method has less complications for the baby?

Sample and Sampling Procedure

A cluster sampling technique was used to draw the sample of pregnant women attending antenatal care services in the study area. First, the healthcare facilities found in Shashemene town were clustered according to their location in the ten kebeles (the smallest administrative unit in Ethiopia) of the town. Then, six healthcare facilities (three public and three private) were purposively selected based on their location in the different parts of the town. Accordingly, three health centers that are adjacent to rural provinces and another two health centers and one general hospital located within the town were considered. In order to determine the sample size, the researchers applied Cochran’s (1977) formula for calculating sample size of unknown population as follows:

(1)

where n is the sample size, z is the selected critical value of desired confidence level, and p is the estimated proportion of an attribute that is present in the population.

Then, the final sample units were chosen on the basis of probability proportionate to size sampling technique. With a 5% contingency and consideration of possible non-response rate, 403 (384+19) copies of the questionnaires were duplicated and distributed. From the distributed questionnaires, 402 were returned, from which 398 were found to be correctly completed.

Data Analysis and Presentation

From the collected questionnaires, the ones that were fully completed and correctly filled were first sorted and, hence, data clearing was undertaken. Then, the completed questionnaires were inserted into SPSS software version 26 for further processing. Data analysis was conducted using statistical techniques, including percentages, frequency distributions, charts, and binary logistic regression analysis. The first three statistical techniques were mainly used to present data regarding the frequency and percentage distributions of responses. It was, for instance, used to show the distribution of socio-demographic characteristics of respondents, pregnant women’s preferences of the mode of delivery, and their reasons for choosing any of the delivery methods, among others. The binary logistic regression test was used to examine the association between socio-demographic characteristics of respondents and their choice of mode of delivery.

Results

According to the data presented in Table 1, respondents in the age group of 26–33 have constituted the majority (50.3%) of the research participants, while those <18 years of age composed 5% of the total respondents. Moreover, 33.4% of respondents reported to have completed secondary school education, followed by 27.1% with college diploma, and 18.8% having a primary level of education. The marital status of the survey participants revealed that most (86.4%) of them were married during the period of data collection and 1.3% were widowed. Furthermore, 45.7% of respondents were Muslims, followed by followers of orthodox Christianity (22.1%). In addition, most (87.7%) respondents were reported to have an urban residential background and the same percentage (87.7%) of survey participants rated their social class status as medium (neither poor nor rich).

Table 1 Socio-Demographic Characteristics of Respondents

It is also shown that the majority (62.1%) of respondents disclosed that they have experienced pregnancy for three and more rounds during the period of data collection, while it was reportedly a first time experience for 15.6% of respondents. Related to this, 37.9% of research participants reported to have two children, followed by those having one child (21.9%), whereas 15.6% of them had no child during the period of the study. Most importantly, findings regarding the previous experience of mode of delivery revealed that most of the respondents (73.1%) had a vaginal mode of delivery while 11.6% reported to have a cesarean section delivery. Above all, 87.4% of respondents disclosed that the medical diagnosis reports about the current health condition of the fetus indicated a healthy or normal status, while 5.5% disclosed health complications were reported.

The Choice of Mode of Delivery

As shown in Table 2, most (69.1%) of respondents have ever been planning about their mode of delivery and 52% of the survey participants disclosed that they intend to deliver through the vagina, while 16.8% of them answered that they were planning to deliver by cesarean section. Furthermore, respondents were asked their preference regarding the mode of delivery under an ideal circumstance that they are fully free to decide on their own. Accordingly, 75.4% of them replied vaginal delivery while 24.6% chose cesarean section. Data regarding respondents’ previous exposure to the information regarding cesarean section revealed that the majority (90.5%) of the study participants were disclosed to have ever heard about cesarean section.

Table 2 Frequency Distribution of Respondents Regarding Their Choice of the Mode of Delivery

In addition, 53.8% of respondents reported to have a close friend or a family member who has delivered through cesarean section. Moreover, the finding pertaining to pregnant women’s freedom of deciding about the mode of delivery have shown that 61.1% of respondents disclosed that they have a freedom to decide whether they have to deliver through normal or cesarean section. Above all, most (73.9%) survey participants perceived that vaginal mode of delivery has less complication on the health of the mother while 51% of respondents held the opinion that cesarean section has less complications on the health of the baby.

The findings in Figure 1 have shown that the majority (36%) of the respondents reported that physicians have the right to decide about the mode of delivery in the community of the research participants, followed by the pregnant women (25%), and both husband and wife (20%).

Figure 1 In your community, who has the right to decide about the mode of delivery?

Data regarding respondents’ reasons for preferring vaginal mode of delivery, as presented in Figure 2, reveal that personal conviction motivated by the need to experience the labor process (50.5%), the belief in it being a natural method (39.9%), the perception that it is better for the wellbeing of both the mother and the child (29.7%), previous experience of delivery by vaginal method (10.9%), fear or the need to avoid episiotomy (6.3%), and economic reasons (5.6%) were the most commonly reported reasons.

Figure 2 Reasons of preferring vaginal/normal delivery.

On the other hand, data pertaining to respondents’ reasons for choosing cesarean section delivery reveal that reduced labor time (33.3%), previous history of cesarean section (32.3%), recommendation from a physician (26.9%), the fact that it is a pain free method (22.6%), fear of pain in vaginal birth (16.1%), the belief that it is safer than vaginal mode of delivery (8.6%), and physical health conditions (7.5%) were the common reasons, as shown in Figure 3.

Figure 3 Reasons for choosing cesarean section delivery.

According to the data presented in Table 3, most (50.3%) respondents disclosed that the first thing that comes to their mind whenever thinking about cesarean section is episiotomy, followed by the financial cost involved in the process (26.1%), its negative implication on subsequent births (24.4%), less pain (19.3%), and it’s being unnatural (17.8%). In addition, it was also found that 41% of respondents responded that they would prefer cesarean section only if recommended by a physician, followed by 34.7% who replied that they will never choose cesarean section unless dictated by conditions that are beyond their capacity, only if normal delivery is risky for the life of both myself and the baby (21.5%), only if normal delivery is risky for the life of both myself and the baby (13.2%), and 11.4% of respondents who replied that they will choose cesarean section even without precondition. Furthermore, 71.7% of respondents perceive that cesarean section is more appropriate for any pregnant women having certain health problems, followed by 30.8% of respondents who believe that it is more appropriate for any woman not interested to deliver by vaginal method, a women with better financial status (6.1%), and all women (5.8%).

Table 3 Perceptions Regarding Cesarean Section Delivery

Factors Associated with Women’s Choice of Mode of Delivery

According to the data presented in Table 4, pregnant women’s preference of the mode of delivery is significantly associated with religion (P<0.001; OR=0.289; 95% CI=0.160–0.520), age (P<0.05; OR=0.672; 95% CI=0.497–0.911), number of children (P<0.001; OR=0.518; 95% CI=0.412–0.652), pregnancy experience (P<0.001; OR=5.000; 95% CI=2.733–9.149), previous mode of delivery (P<0.001; OR=0.050; 95% CI=0.020–0.126), self-rated social class status (P<0.01; OR=12.250; 95% CI=2.370–63.316), experiences of planning about mode of delivery (P<0.01; OR=2.776; 95% CI=1.284–5.997), autonomy to decide about mode of delivery (P<0.01; OR=0.395; 95% C.I: 0.199–0.784), ever heard about cesarean section (P<0.05; OR=0.153; 95% CI=0.036–0.647), perceptions regarding the mode of delivery having less health complications for the baby (P<0.01; OR=2.764; 95% CI=1.379–5.543), perceptions regarding the mode of delivery having less health complications for the mother (P<0.05; OR=1.746; 95% CI=1.045–2.918), and type of healthcare organization of antenatal care attendance (P<0.01; OR=2.237; 95% CI=1.334–3.752).

Table 4 Results of Binary Logistic Regression Analysis

Accordingly, it is shown that the choice of cesarean section increases with increasing age (P<0.05). The association between religion and choice of mode of delivery revealed that preference of cesarean section has been most common in followers of Orthodox Christianity while most Muslims preferred vaginal mode of delivery than followers of all other religions. Furthermore, the choice of cesarean section increased with decreasing number of children and vice-versa. It was also found that the likelihood of pregnant women to prefer cesarean section delivery increases with the previous mode of delivery being by cesarean section and vice versa in which the association is significant (P<0.001). In addition, the choice of mode of delivery is strongly associated with respondents’ self-rated social class status in such a way that the more affluent respondents become, the more likely they are to prefer cesarean section and the choice of vaginal delivery increases with decrease in class status (P<0.01). Data have also shown that pregnant women’s likelihood of preferring cesarean section mode of delivery increases for those women who attend antenatal care in private healthcare facilities, compared to those attending in the public healthcare facilities (P<0.01).

Moreover, the coefficient of regression has also shown that pregnant women’s preference of cesarean section delivery increases with increased autonomy to make decisions regarding the mode of delivery (P<0.01). The same generalization can also be made about respondents who have ever heard about cesarean section, ie, the more pregnant women have ever heard about cesarean section, the more likely they are to prefer cesarean section (P<0.05). Above all, it is also indicated that the preference of cesarean section is strongly associated with respondents’ perceptions regarding which mode of delivery is less risky both for the mother as well as for the child. In other words, the more respondents perceived that cesarean section is less risky for the baby, the more likely they become to prefer cesarean section (P<0.01).

Discussion

The mode of delivery influences the perceived control, the characteristics of the emotional experience, and the first moments with the newborn.25 It also interferes with the early initiation of breastfeeding.26 Therefore, knowledge about women’s views, experiences, preferences, and social values related to mode of delivery and identification of the factors influencing such choices help explain the decision-making processes about mode of childbirth, decrease the cesarean section rate, increase its access to those who need it the most and improve women’s health.12,27 The present study aimed at identifying the preferences of mode of delivery and the factors influencing such choices of pregnant women attending antenatal care in public and private healthcare facilities of southern Ethiopia. Quantitative data were collected from randomly selected pregnant women, inserted into SPSS software version 26, and analyzed using both descriptive and inferential statistical techniques. Accordingly, it was found that under circumstances by which the women get the autonomy to make decisions on their own (without intervention from other persons or medical complications) regarding their mode of delivery, most of the respondents replied that they prefer vaginal or normal delivery.

The findings of the present research differ from the findings of a related study conducted in Eastern Ethiopia by Welay et al,24 which found that nearly one-third of the mothers preferred cesarean section due to fear of labor pain and repeated vaginal examination by the healthcare providers. Perhaps this inconsistency could be attributed to methodological differences between the two studies. For instance, in their study, Welay et al24 excluded pregnant women who have previously delivered through cesarean section and those who had previous uterine rupture. The present study differs from this research in the sense that it includes all pregnant women in the study area attending antenatal care in both private and public healthcare facilities. Moreover, the two studies have also been undertaken in areas having different socio-cultural characteristics which would justifiably lead us to expect different findings. Other studies in Ethiopia undertaken on a survey population, ie, women who have been admitted to healthcare facilities and attending postnatal care, have shown a high prevalence rate of cesarean section delivery.10,28–34

Related studies conducted outside of Ethiopia, however, have revealed findings that are consistent with the results of the present study. For instance, the findings of a study conducted by Loke et al35 found that without medical and financial considerations, the significant majority (79%) of women preferred vaginal birth. In addition, Adageba et al36 found that the majority of antenatal clients in Ghana preferred vaginal delivery. Moreover, the study of Ogunlaja et al37 revealed that women in South West Nigeria have a good awareness about the issues involved in delivering through cesarean section and that most women agreed that cesarean section is as safe as vaginal delivery, where the majority of these women had a better educational status. Furthermore, a study undertaken in four hard to reach areas of Bangladesh27 found a low prevalence of cesarean section delivery which was below the national average. Moreover, Liu et al20 found that most Argentinean women preferred vaginal delivery due to cultural, personal, and social factors. Most importantly, they indicated that women in their study positively viewed pain associated with vaginal delivery and cesarean section was treated as a medical decision in which some women have deviated from the decisions of medical staff even in the presence of medical conditions. Above all, Favilli et al38 concluded that women’s preferences about labor are focused on both pain relief and labor duration.

Whereas most pregnant women participating in the present study preferred normal/vaginal mode of delivery, the most commonly mentioned reasons for the choice of vaginal delivery include personal conviction motivated by the need to experience the labor process, the belief in it being a natural method, the perception that it is better for the wellbeing of both the mother and the child, previous experience of delivery by vaginal method, fear or the need to avoid episiotomy, and economic reasons. On the other hand, data pertaining to respondents’ reasons for choosing cesarean section delivery reveal that reduced labor time, previous history of cesarean section, recommendation from a physician, the fact that it is a pain free method, fear of pain in vaginal birth, the belief that it is safer than vaginal mode of delivery, and physical health conditions were the common reasons. Similarly, a study by Kasai et al21 revealed that most women in Brazil expressed a preference for vaginal birth, in the belief that vaginal delivery involves less suffering, better recovery, lesser risk, is quicker, and, hence, allows earlier discharge from healthcare facilities, and is better for the wellbeing of both the mother and her babies. In addition, Loke et al35 indicated that the most frequently cited reasons for the choice of normal delivery were concerns for the health of the newborn, concern for maternal health, and being a natural way of delivery, whereas the reasons for cesarean section include avoidance of labor pain, concerns for the health of the newborn, and concerns for maternal health. According to Shi et al,8 abnormalities in prenatal examinations, lack of confidence in vaginal birth, fear of pain during vaginal birth, and the desire to select time of birth and health birth systems influence the choice of cesarean section. Moreover, considering cesarean section as safe for both mother and baby,the belief that it is a pain-free method of delivery, friends’ advice, and religious advice have been the reasons for choosing cesarean section among women, according to Konlan et al.19

According to Roudsari et al,12 social, religious, and cultural beliefs significantly affect individuals’ attitudes towards modes of delivery, their definitions of these modes, and the choices they make in addition to determining how a pregnant women perceives, interprets, and deals with pain during labor and how she selects pain management methods during delivery. The findings of the present study have shown that pregnant women’s preference of the mode of delivery is significantly associated with religion, age, number of children, pregnancy experience, previous mode of delivery, self-rated social class status, experiences of planning about mode of delivery, autonomy to decide about mode of delivery, ever heard about cesarean section, perceptions regarding the mode of delivery having less health complications for the baby, perceptions regarding the mode of delivery having less health complications for the mother, and type of healthcare organization of antenatal care attendance.

These findings are consistent with other previously undertaken studies on related topics. For instance, Murphy and Fahey13 found that the rate of cesarean section and vaginal operative delivery increases with admission to private hospitals compared to those that deliver at public healthcare facilities. In addition, other studies30,31 also revealed that the prevalence of cesarean section was higher in women who gave birth in a private health facility, mothers having risk factors, and mothers having an educational status of diploma and above. Furthermore, the findings of Konlan et al19 revealed a significant positive correlation between average monthly income and the number of times of having cesarean section, while age has not shown a positive correlation with the number of times of having a cesarean section. Moreover, Amjad et al14 adds factors such as getting older, living in an urban area, being from the richest social class, higher educational status, employment at managerial or technical level, having pregnancy complications, higher utilization of antenatal care, and delivering babies at private hospitals to be associated with the likelihood of cesarean section deliveries. Omona39 also found a high rate of cesarean section delivery in a private-non-for-profit healthcare organization. Above all, Tenaw et al10 found factors such as monthly income above the poverty line, previous pregnancy complications, and current obstetric problems were significantly associated with increasing prevalence of cesarean section while utilization of a partograph lowers the odds of cesarean section.

In contrast, Karim et al27 found socio-demographic factors such as women’s religion, education, and occupation, husband’s education, household’s wealth quintile, whether the woman was the owner of mobile or not and obstetric factors such as the number of ANC visits and presence of any complications during pregnancy were not significantly associated with C-section whereas delivering in private facilities and complications during childbirth were positively associated with cesarean section birth. After studying mode of delivery among women with a history of prior cesarean birth in the South Western part of Ethiopia, Margo et al40 found that most of the women with the history of cesarean section delivery have attempted a trial of labor after cesarean section, where women that were successful were more likely to have been more cervically dilated on their admission exam. Birara and Gebrehiwot41 found that successful vaginal delivery after one previous cesarean scar was associated with past obstetric performance and mainly to the current labor in which the main determinant factors include history of still birth, history of successful vaginal birth after cesarean section delivery, rupture of membrane, absence of meconium, cervical stage of labor at admission, position of the presenting part, duration of labor, and knowledge of the previous indication for the past cesarean section.

The findings of the present study have also shown that other socio-demographic factors such as educational status, marital status, and residential background were not significantly associated with pregnant women’s preference of mode of delivery. Consistent to this, previous related studies conducted both in other parts of Ethiopia and in other countries have found an association between these variables and the independent variable. For instance, Welay et al24 found level of education, planned pregnancy, age, choice of place of delivery, frequency of antenatal care attendance, and primigravida were the factors associated with pregnant women’s preference of cesarean section delivery.

In addition, Sayiner et al11 found education, age at marriage, history of abortus in the previous delivery, and the number of living children as factors significantly associated with preferences of modes of delivery in which women with a better educational status, having the experience of delayed marriage, those having a previous history of abortus, and women having no living children prefer cesarean section than vaginal delivery. Moreover, the fear of normal birth, doctor’s demand, and thinking cesarean section is healthier were found to be the reasons for the choice of cesarean section. On the other hand, women who believed normal birth healthier, it’s being spontaneous in hospital, wishing to get better soon, and having low economic status preferred normal delivery, according to the findings of the study. Above all, rural residence, fetal weight greater than 2,500 gm and previous history of stillbirth were independent predictors of cesarean section.32 Mose and Abebe34 found that mothers residing in an urban area, having had multiple pregnancies, malpresentation, and a previous history of cesarean section were factors associated with cesarean section deliveries.

Conclusion

The findings of the present study have highlighted that normal or vaginal method has remained the most preferred mode of delivery among most pregnant women attending antenatal care services in Southern Ethiopia. Personal conviction motivated by the need to experience the labor process, the belief in it being a natural method, the perception that it is better for the wellbeing of both the mother and the child, previous experience of delivery by vaginal method, fear or the need to avoid episiotomy, and economic concerns have been mentioned as reasons for the choice of vaginal delivery. Nevertheless, this generalization should be noted without undermining the fact that the choice of cesarean section is still increasing among women expecting a baby. Even in the context of this study, about a quarter of pregnant women have reported that they prefer to deliver by cesarean section, a prevalence rate which is higher than the national average (2%). The study has also shown that the choice of cesarean section was motivated by reasons such as reduced labor time, previous history of cesarean section, recommendation from a physician, the fact that it is a pain free method, fear of pain in vaginal birth, the belief that it is safer than vaginal mode of delivery, and physical health conditions. In Ethiopia, health education programs pertaining to the pros and cons of alternative modes of child delivery are not common, which might have contributed to the knowledge gap that makes decision-making very difficult. Therefore, it is suggested that further tasks related to educating pregnant women and creating awareness using various media platforms about advantages and disadvantages of cesarean section mode of delivery should be undertaken by all concerned bodies of the government, especially the federal Ministry of Health.

Data Sharing Statement

The data used to support the findings of this study are available from the corresponding author upon reasonable request.

Ethics Approval and Consent to Participate

The study was evaluated and approved by the Ethics Approval Committee of Dilla University (DU-HSC/1529/14). The ethics committee has approved that participants under the age of 18 years can be provided informed consent on their own behalf. Research participants were first informed about the purpose of the research, including what role is expected from their side. Both verbal and written consents were gained from all research participants. In addition, a formal letter was obtained from Senabor College. This study was conducted in accordance with the relevant guidelines and complies with the Declaration of Helsinki.

Acknowledgments

We would like to offer our heartfelt gratitude to Senabor College, Shashemene campus for providing all the financial and material support needed to undertake the study. In addition, we would also thank Yeshi Abate and other clinical nurses who have been serving in the healthcare facilities during the period of the study for their contribution during data gathering. Furthermore, Betsiat Tilahun who has been helping us during data clerk also deserves appreciation.

Funding

The finance needed to undertake this study was covered by Senabor College, Shashemene campus.

Disclosure

The authors declare no conflicts of interest in relation to this work.

References

1. World Health Organization. WHO Recommendations Non-Clinical Interventions to Reduce Unnecessary Caesarean Sections. Geneva: World Health Organization; 2018. Licence: CC BY-NC-SA 3.0 IGO.

2. World Health Organization. WHO statement on caesarean section rates. World Health Organization; 2015. WHO/RHR/15.02. Available from: https://apps.who.int/iris/bitstream/handle/10665/161442/WHO_RHR_15.02_eng.pdf. Accessed July 8, 2022.

3. Thanh BYL, Lumbiganon P, Pattanittum P, et al. Mode of delivery and pregnancy outcomes in preterm birth: a secondary analysis of the WHO Global and Multi-country Surveys. Sci Rep. 2019;9:15556. doi:10.1038/s41598-019-52015-w

4. Berhan Y, Haileamlak A. The risks of planned vaginal breech delivery versus planned caesarean section for term breech birth: a meta-analysis including observational studies. Int J Gynaecol Obstet. 2016;13(1):49–57. doi:10.1111/1471-0528.13524

5. Adane F, Mulu A, Seyoum G, Gebrie A, Lake A. Prevalence and root causes of surgical site infection among women undergoing caesarean section in Ethiopia: a systematic review and meta-analysis. Patient Saf Surg. 2019;13:34. doi:10.1186/s13037-019-0212-6

6. Regan J, Thompson A, DeFranco E. The influence of mode of delivery on breastfeeding initiation in women with a prior caesarean delivery: a population-based study. Breastfeed Med. 2013;8(2):181–186. doi:10.1089/bfm.2012.0049

7. Betran A, Temmerman M, Kingdon C, et al. Interventions to reduce unnecessary caesarean sections in healthy women and babies. Lancet. 2018;392(10155):P1358–P1368.

8. Shi Y, Jiang Y, Zeng Q, et al. Influencing factors associated with the mode of birth among childbearing women in Hunan Province: a cross-sectional study in China. BMC Pregnancy Childbirth. 2016;16(108):1–9. doi:10.1186/s12884-016-0897-9

9. Hannah M. Planned elective caesarean section: a reasonable choice for some women? Can Med Assoc J. 2004;170(5):813–814. doi:10.1503/cmaj.1032002

10. Tenaw Z, Kassa Z, Kassahun G, Ayenew A. Maternal preference, mode of delivery and associated factors among women who gave birth at public and Private Hospitals in Hawassa City, Southern Ethiopia. Ann Glob Health. 2019;85(1):115. doi:10.5334/aogh.2578

11. Sayiner F, Ozerdogan N, Giray S, Ozdemir E, Savei A. Identifying the women’s choice of delivery methods of and the factors that affect them. J Perinat. 2009;17(3):104–112.

12. Roudsari R, Zakerihamidi M, Khoei E. Socio-cultural beliefs, values and traditions regarding women’s preferred mode of birth in the North of Iran. Int J Community Based Nurs Midwifery. 2015;3(3):165–176.

13. Murphy DJ, Fahey T. A retrospective cohort study of mode of delivery among public and private patients in an integrated maternity hospital setting. BMJ Open. 2013;3:e003865. doi:10.1136/bmjopen-2013-003865

14. Amjad A, Amjad U, Zakar R, et al. Factors associated with caesarean deliveries among child-bearing women in Pakistan: secondary analysis of data from the demographic and health survey, 2012–13. BMC Pregnancy Childbirth. 2018;18:113. doi:10.1186/s12884-018-1743-z

15. Silva T, Dumont-Pena E, Moreira A, et al. Factors associated with normal and caesarean delivery in public and private maternity hospitals: a cross-sectional study. Rev Bras Enferm. 2020;73(suppl 4). doi:10.1590/0034-7167-2018-0996

16. Das P, Samad N, Sapkota A, et al. Prevalence and factors associated with caesarean delivery in Nepal: evidence from a nationally representative sample. Cureus. 2021;13(12):e20326. doi:10.7759/cureus.20326

17. Alabdullah HA, Ismael L, Alshehri LA, et al. The prevalence of C-section delivery and its associated factors among Saudi women attending different clinics of King Khalid University Hospital. Cureus. 2021;13(1):e12774. doi:10.7759/cureus.12774

18. Wang L, Xu X, Baker P, et al. Patterns and associated factors of caesarean delivery intention among expectant mothers in China: implications from the implementation of China’s New National Two-Child Policy. Int J Environ Res Public Health. 2016;13(7):686. doi:10.3390/ijerph13070686

19. Konlan K, Baku E, Japiong M, Konlan K, Amoah R. Reasons for women’s choice of elective caesarean section in Duayaw Nkwanta hospital. J Pregnancy. 2019;2019:2320743. doi:10.1155/2019/2320743

20. Liu NH, Mazzoni A, Zamberlin N, et al. Preferences for mode of delivery in nulliparous Argentinean women: a qualitative study. Reprod Health. 2013;10:1–7. doi:10.1186/1742-4755-10-2

21. Kasai KE, Nomura RM, Benute GR, de Lucia MC, Zugaib M. Women’s opinions about mode of birth in Brazil: a qualitative study in a public teaching hospital. Midwifery. 2010;26(3):319–326. doi:10.1016/j.midw.2008.08.001

22. Yaya S, Uthman OA, Amouzou A, et al. Disparities in caesarean section prevalence and determinants across sub-Saharan Africa countries. Glob Health Res Policy. 2018;3:19. doi:10.1186/s41256-018-0074-y

23. Yisma E, Smithers LG, Lynch JW, Mol BW. Caesarean section in Ethiopia: prevalence and sociodemographic characteristics. J Matern Fetal Neonatal Med. 2019;32(7):1130–1135. PMID: 29103331. doi:10.1080/14767058.2017.1401606

24. Welay F, Gebresilassie B, Asefa G, Mengesha M. Delivery mode preference and associated factors among pregnant mothers in Harar regional state, Eastern Ethiopia: a cross-sectional study. BioMed Res Int. 2021;2021:1–7. doi:10.1155/2021/1751578

25. Guittier M, Cedraschi C, Jemei N, Boulvain M, Guillemin F, Impact of mode of delivery on the birth experience in first-time mothers: a qualitative study. BMC Pregnancy Childbirth. 2014;14(1):1–9. doi:10.1186/1471-2393-14-254

26. Taha Z, Hassan A, Wikkeling-Scott L, Papandreou D. Prevalence and associated factors of caesarean section and its impact on early initiation of breastfeeding in Abu Dhabi, United Arab Emirates. Nutrients. 2019;11(11):2723. doi:10.3390/nu11112723

27. Karim F, Ali NB, Khan ANS, et al. Prevalence and factors associated with caesarean section in four Hard-to-Reach areas of Bangladesh: findings from a cross-sectional survey. PLoS One. 2020;15(6):e0234249. doi:10.1371/journal.pone.0234249

28. Muleta G, Moges A, Ademe B. Prevalence and outcome of caesarean section in Attat Hospital, Gurage zone, SNNPR, Ethiopia. Arch Med. 2015;7(4):8.

29. Bago BJ. Prevalence and its associated factors among women undergone operative delivery at Hawassa University Comprehensive Specialized Hospital, Southern Ethiopia, 2017. Gynecol Obstet. 2018;8:461. doi:10.4172/2161-0932.1000461

30. Tsegaye H, Desalegne B, Wassihun B, et al. Prevalence and associated factors of caesarean section in Addis Ababa, Ethiopia. Pan Afr Med J. 2019;34:136. doi:10.11604/pamj.2019.34.136.16264

31. Melesse MB, Geremew AB, Abebe SM. High prevalence of caesarean birth among mothers delivered at health facilities in Bahir Dar city, Amhara region, Ethiopia. A comparative study. PLoS One. 2020;15(4):e0231631. doi:10.1371/journal.pone.0231631

32. Shitu S, Shifera A, Eyado R, et al. Prevalence of caesarean section and associated factor among women who give birth in the last one year at Butajira General Hospital, Gurage Zone, SNNPR, Ethiopia, 2019. Int J Pregn Chi Birth. 2020;6(1):16‒21. doi:10.15406/ipcb.2020.06.00188

33. Gedefaw G, Demis A, Alemnew B, et al. Prevalence, indications, and outcomes of caesarean section deliveries in Ethiopia: a systematic review and meta-analysis. Patient Saf Surg. 2020;14:11. doi:10.1186/s13037-020-00236-8

34. Mose A, Abebe H. Magnitude and associated factors of caesarean section deliveries among women who gave birth in Southwest Ethiopia: institutional-based cross-sectional study. Arch Public Health. 2021;79:158. doi:10.1186/s13690-021-00682-5

35. Loke A, Davies L, Li S. Factors influencing the decision that women make on their mode of delivery: the health belief model. BMC Health Serv Res. 2015;15:1–12. doi:10.1186/s12913-015-0931-z

36. Adageba A, Danso KA, Adusu-Donkor A, Kakroe A. Awareness and perception of and attitudes towards Caesarean section among antenatal client. Ghana Med J. 2008;42(4):137–140.

37. Ogunlaja O, Ogunlaja I, Akinola S, Aworinde O. Knowledge, attitude and willingness to accept caesarean section among women in Ogbomoso, southwest Nigeria. South Sudan Med J. 2018;11(4):89–92.

38. Favilli A, Laganà AS, Indraccolo U, et al. What women want? Results from a prospective multicenter study on women’s preference about pain management during labour. Eur J Obstet Gynecol Reprod Biol. 2018;228:197–202. PMID: 29990827. doi:10.1016/j.ejogrb.2018.06.038

39. Omona K. Determinants of caesarean section rates in private-not-for-profit healthcare facilities: St Joseph’s Hospital_ Kitovu. Cogent Med. 2021;8(1). doi:10.1080/2331205X.2021.1928939

40. Margo S, Tewodros L, Ephrem K, et al. Mode of delivery among women with a history of prior caesarean birth at Mizan-Tepi University Teaching Hospital. J Women’s Health Dev. 2021;4:1–9.

41. Birara M, Gebrehiwot Y. Factors associated with success of vaginal birth after one caesarean section (VBAC) at three teaching hospitals in Addis Ababa, Ethiopia: a case control study. BMC Pregnancy Childbirth. 2013;13:31. doi:10.1186/1471-2393-13-31

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