Expectation and Experiences of Childbirth in Primiparae With Cesarean Section

Cesarean section (CS) upon maternal request is common in many countries. Whether or not abdominal delivery should be carried out upon maternal request is a complex and controversial issue involving maternal fear of pain during labor, pelvic floor injuries, loss of baby, or of being left without assistance during labor weighed against the risk of CS versus instrumented vaginal delivery. This prospective cohort study investigated whether the birth expectations of vaginal delivery differ between first-time mothers with a normal pregnancy who request a CS, firsttime mothers with a scheduled elective CS due to breech presentation, and first-time mothers planning a vaginal delivery. A second analysis examined how emergency CS or delivery with vacuum extraction (VE) or forceps among women planning a vaginal birth affected their impression of the birth experience. A total of 496 healthy first-time mothers were recruited at 37 to 39 weeks’ gestation. Of those who planned a birth with elective CS either upon maternal request or for nonvertexpresentation, 104underwentCSonmaternal request and128hadCSforabreech.Thesegroupswerecomparedwith 264 women planning a vaginal birth, who were divided into those who had a spontaneous vaginal delivery, those who had assisted VE vaginal delivery (16%), and those who had an emergency CS (14%). The Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ; both versions A and B) was used to assess maternal experience, which measures the degree of fear of childbirth or negative reactions to delivery. The score was scaled between 0 and 100. The higher the score, the greater the fear of childbirth manifested. The usual maternal demographic data were recorded and compared. Of a total of 204 first-time mothers having CS on maternal request, 104 were included in the study. The main reason for the dropout before birth was the short time between thearrival of thepostedquestionnaire and thebaby’s birth. There were no statistically significant differences in dropouts in the three groups in relation to age, university education, experience of poor health, or smoking habits. Women who requested CS were more often born outside Sweden (P<0.003) and were older (33.9 vs. 30.8 years; P<0.001) than women in the other groups.Women requesting a CS had a significantly higher W-DEQ total score (80.8 versus 59.0; P<0.001) compared with women in the other groups (vaginal delivery, emergency CS, assisted vaginal delivery, CS due to breech presentation). A score above 84, the cut-off point for clinically significant fear of childbirth, was found in 13.2%of the vaginal group, 6% in those having CS due to breech presentation, and 43.4% in the CS on maternal request group. A very severe fear of childbirth (score >100) was present in 28% of the ‘‘requesting CS’’ group compared to 5% and 3%, respectively, for the vaginal and CS due to breech presentation groups (P<0.001). Mothers in the maternal CS request group were more afraid than the other groups, felt less happy before delivery, and were more afraid the child would die.Mothers with a CS due to breech presentation were more afraid of behaving badly during the delivery compared to the other groups. Mothers who expected a vaginal delivery but who had an emergency CS or VE vaginal delivery had significantly more negative experiences of delivery than the women who had a normal vaginal delivery orCS due to breech or upon request. Among the 246 patients who completed bothAandBquestionnaires, mothers with higher positive expectancy scores had a more positive delivery experience except for those with an elective CS on request, in which no significant relationship between expectancy and experience was found. First-time mothers who request an elective CS have an increased fear of childbirth compared to other first-time mothers. Women who had complicated deliveries reported more negative birth experiences. Those who fear childbirth might have their fear reduced through better counseling and support.