Advertisement

Archives of Gynecology and Obstetrics

, Volume 300, Issue 1, pp 33–40 | Cite as

Is age and socioeconomic status associated with preference for birth mode in nulliparous women in China?

  • Yanhong Ming
  • Rong HuangEmail author
  • Wei Zhou
  • Bin Wang
  • Hongping YuEmail author
  • Jun Zhang
  • For the Shanghai Birth Cohort
Maternal-Fetal Medicine
  • 32 Downloads

Abstract

Purpose

To examine the association between sociodemographic factors and preference for birth mode in nulliparous women in China.

Methods

A total of 4606 women before or in early pregnancy were recruited from 2013 to 2016 in the Shanghai Birth Cohort Study. Generalized linear regression was used to examine the association of sociodemographic characteristics with preferred birth mode and actual cesarean section (CS) without clinical indications in 2713 nulliparous women, and the changes from preference of vaginal birth to actual CS without clinical indications in 2369 nulliparous women.

Results

After controlling for potential confounders, preference for CS was associated with older maternal age [31–34 years: adjusted risk ratio (ARR) 2.73, 95% confidence interval (CI) 1.56–4.78; ≥ 35 years: 6.27, 3.28–12.01, p for trend < 0.0001] and lower level of education (below junior college vs college or above: 1.51, 1.10–2.09). Older maternal age (≥ 35 years: 3.37, 1.74–6.50), born in city or township (city vs countryside: 3.18, 1.93–5.24; township vs countryside: 1.97, 1.06–3.66), and lower level of education (below junior college vs college or above: 1.38, 1.01–1.88) were significantly associated with a CS without clinical indications. Women who preferred vaginal birth but had an actual CS without clinical indications were more likely to be older (≥ 35 years: 4.30, 1.44–12.83) and born in city (city vs countryside: 2.89, 1.33–6.30).

Conclusions

Older age, lower education level, and being born in city or township were risk factors for CS without clinical indication in China.

Keywords

Cesarean section without clinical indications Preference for birth mode Sociodemographic factors 

Notes

Acknowledgements

We would like to thank the Shanghai Municipal Commission of Health and Family Planning and all participating women for joining the study. This study was partly funded by the Shanghai Municipal Commission of Health and Family Planning (GWIII-26, GWIV-26, and 20174Y0133), National Natural Science Foundation of China (81803246), Shanghai Jiao Tong University 985 Fund, and the National Human Genetic Resources Sharing Platform (2005DKA21300). This funding body had no role in the study design, data collection, analysis, interpretation of data, and writing the manuscript.

Author contributions

YHM analyzed the data and drafted the manuscript. RH and HPY conceptualized the study, made significant contribution to the data analysis, and critically revised the manuscript. WZ and BW coordinated the study and revised the manuscript. JZ critically revised the manuscript. All authors read and approved the final manuscript.

Funding

We would like to thank the Shanghai Municipal Commission of Health and Family Planning and all participating women for joining the study. This study was partly funded by the Shanghai Municipal Commission of Health and Family Planning (GWIII-26, GWIV-26 and 20174Y0133), National Natural Science Foundation of China (81803246), Shanghai Jiao Tong University 985 Fund, and the National Human Genetic Resources Sharing Platform (2005DKA21300). This funding body had no role in the study design, data collection, analysis, interpretation of data, and manuscript writing.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

Ethical approval was obtained from the Ethics Committee of Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China (Protocol no. XHEC-C-2013–001-2).

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Karlström A, Lindgren H, Hildingsson I (2013) Maternal and infant outcome after caesarean section without recorded medical indication: findings from a Swedish case–control study. BJOG Int J Obstet Gynaecol 120(4):479CrossRefGoogle Scholar
  2. 2.
    Souza J et al (2010) Caesarean section without medical indications is associated with an increased risk of adverse short-term maternal outcomes: the 2004–2008 WHO Global Survey on Maternal and Perinatal Health. BMC Med 8(1):71CrossRefGoogle Scholar
  3. 3.
    Curran E et al (2015) Research review: birth by caesarean section and development of autism spectrum disorder and attention-deficit/hyperactivity disorder: a systematic review and meta-analysis. J Child Psychol Psychiatry 56(5):500–508CrossRefGoogle Scholar
  4. 4.
    Rusconi F et al (2017) Mode of delivery and asthma at school age in 9 european birth cohorts. Am J Epidemiol 185(6):465–473CrossRefGoogle Scholar
  5. 5.
    Betrán AP et al (2016) The increasing trend in caesarean section rates: global, regional and national estimates: 1990–2014. PLoS One 11(2):e0148343CrossRefGoogle Scholar
  6. 6.
    Hou L et al (2014) Cesarean delivery rate and indications in mainland China: a cross sectional study in 2011. Chin J Obstet Gynecol 49(10):728–735Google Scholar
  7. 7.
    Liu Y et al (2014) A descriptive analysis of the indications for section in mainland China. BMC Pregnancy Childbirth 14(1):1–9CrossRefGoogle Scholar
  8. 8.
    Hu Y, Tao H, Cheng Z (2015) Caesarean sections in Beijing, China—results from a descriptive study. Gesundheitswesen 78(01):e1–e5CrossRefGoogle Scholar
  9. 9.
    Feng XL et al (2014) Cesarean section in the People's Republic of China: current perspectives. Int J Womens Health 6:59–74CrossRefGoogle Scholar
  10. 10.
    Zhang J et al (2008) Cesarean delivery on maternal request in southeast China. Obstet Gynecol 111(5):1077CrossRefGoogle Scholar
  11. 11.
    Angeja A et al (2006) Chilean women’s preferences regarding mode of delivery: which do they prefer and why? BJOG Int J Obstet Gynaecol 113(11):1253–1258CrossRefGoogle Scholar
  12. 12.
    Mazzoni A et al (2011) Women's preference for caesarean section: a systematic review and meta-analysis of observational studies. BJOG 118(4):391–399CrossRefGoogle Scholar
  13. 13.
    Torloni MR et al (2013) Do Italian women prefer cesarean section? Results from a survey on mode of delivery preferences. BMC Pregnancy Childbirth 13(1):78CrossRefGoogle Scholar
  14. 14.
    Wang L et al (2016) 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 Pub Health 13(7):686CrossRefGoogle Scholar
  15. 15.
    Zhang H et al (2017) Predictors of preference for caesarean delivery among pregnant women in Beijing. J Int Med Res 45(2):798CrossRefGoogle Scholar
  16. 16.
    Blomberg M, Tyrberg RB, Kjolhede P (2014) Impact of maternal age on obstetric and neonatal outcome with emphasis on primiparous adolescents and older women: a Swedish Medical Birth Register Study. BMJ Open 4(11):e005840CrossRefGoogle Scholar
  17. 17.
    Ramachandran N et al (2015) Obstetric and perinatal outcome of elderly mothers aged 35 years and above: a comparative study. Int J Res Med Sci 3(1):214–219Google Scholar
  18. 18.
    Feng XL et al (2012) Factors influencing rising caesarean section rates in China between 1988 and 2008. Bull World Health Org 90(1):30–39ACrossRefGoogle Scholar
  19. 19.
    Hsu KH, Liao PJ, Hwang CJ (2008) Factors affecting Taiwanese women's choice of cesarean section. Soc Sci Med 66(1):201CrossRefGoogle Scholar
  20. 20.
    Lee SI, Khang YH, Lee MS (2004) Women's attitudes toward mode of delivery in South Korea—a society with high cesarean section rates. Birth 31(2):108CrossRefGoogle Scholar
  21. 21.
    Barbadoro P et al (2012) Caesarean delivery in South Italy: women without choice. A cross sectional survey. PLoS One 7(9):e43906CrossRefGoogle Scholar
  22. 22.
    Davari M et al (2014) The relationship between socioeconomic status and the prevalence of elective cesarean section in nulliparous women in Niknafs Teaching Centre in Rafsanjan, Iran. Womens Health Bull 1(2):e20044Google Scholar
  23. 23.
    Faisalcury A et al (2017) The relationship between indicators of socioeconomic status and cesarean section in public hospitals. Rev Saúde Pública 51:14Google Scholar
  24. 24.
    Hellerstein S, Feldman S, Duan T (2015) China's 50% caesarean delivery rate: is it too high? BJOG Int J Obstet Gynaecol 122(2):160CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.School of Public HealthGuilin Medical UniversityGuilinChina
  2. 2.Department of Obstetrics and Gynecology, Xiangya HospitalCentral South UniversityChangshaChina
  3. 3.Ministry of Education-Shanghai Key Laboratory of Children’s Environmental Health, Xinhua HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
  4. 4.Guangxi Medical University Affiliated Cancer HospitalNanningChina
  5. 5.Department of Epidemiology, School of Public HealthGuangxi Medical UniversityNanningChina

Personalised recommendations