Preference for mode of delivery in a low risk population in Cape Town, South Africa

Master Thesis


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University of Cape Town

Introduction: Over the past few decades there has been an increase in caesarean section rates that has been well documented in many developed countries. The impact of this cannot be ignored as several studies have shown higher risks of maternal morbidity and mortality with caesarean section as compared to vaginal births. The reasons behind it are complex, with maternal request frequently being cited as a major contributor. A growing body of evidence shows that relatively few women would actually prefer to deliver by caesarean section. Caesarean section on request is not routinely offered in the public health care sector in South Africa, and is therefore unlikely to contribute significantly to the overall caesarean section rate. In the South African context very few studies examining women's preference for mode of delivery exist. Aims and Objectives: The primary aim of our study was to determine women's preference for mode of delivery during the third trimester of pregnancy in a low risk population. The secondary outcome was to describe the major reasons for their preferred mode of delivery. Methodology: We conducted a cross-sectional descriptive study of pregnant women attending antenatal care at two midwife obstetric units (MOUs) in Gugulethu and Mitchell's Plain in the Western Cape. Women were recruited during the third trimester of pregnancy and women over the age of 18, with a singleton low risk pregnancy, planning to deliver at the MOU, were eligible for inclusion. Two trained interviewers conducted an interview-based questionnaire regarding women's preference for mode of delivery. Data on demographic and socio-economic characteristics were also collected. We also described the major reasons behind women's preferred mode of delivery. Results: Of the 195 women that participated in our study, 160 (82.1 %) indicated a preference for vaginal delivery. This compared to only 5 (2.6 %) of the study participants who preferred a caesarean delivery, and 30 women (15.4 %) who were unsure about their preferred mode of delivery. Of the group preferring caesarean section, all five women (100 %) cited 'fear of vaginal birth' as the major reason for preferring a caesarean section. Of the 195 women that participated in our study, 106 (54.4 %) did not believe that women should be given the right to request a caesarean section in the absence of a medical indication, 14 women were unsure (7.2 %) and 75 of them believe that women should have the right to request a caesarean (38.5 %). Conclusion: The need for maternity services that are more women-centred has arisen, with an increasing emphasis on maternal choice and birth satisfaction. Our study contributed to the mounting body of evidence that the majority of women prefer to have a vaginal delivery. In the small group preferring caesarean section, 'fear of vaginal birth' was the major reason behind their preference. There were a considerable number of women in our study population who were unsure about their preference. This indicates a need for improved antenatal education. Knowledge about women's preference and the reasons they regard as important will aid health care providers in counselling patients appropriately regarding the risks and benefits of both delivery methods and thereby enable women to make an informed decision about their preferred mode of delivery.

Includes bibliographical references