Women’s Views and Preferences for Mode of Birth in Public Hospitals in Argentina: a Mixed-methods Study

Background: This research explores women’s preferences for mode of birth (MOB) and their opinions on the advantages and disadvantages of MOB in public maternity hospitals with caesarean section (CS) rates higher than 30% in Argentina.Methods: Five public hospitals participated in this sequential mixed methods research. Post-partum women took part in semi-structured interviews which gathered information on obstetric history, MOB preferences, companionship, opinions on each MOB and if they would have liked to be asked about their MOB. The interviews were subsequently coded for quantitative analysis. A multiple regression model was run to explore variables associated with preferred MOB. Results: The interviews took place during eight weeks in 2019. The participating hospitals had limited availability to pain management interventions during birth. Participants were 621 women with a mean age of 26 +6. Forty percent had had a previous caesarean section (CS). Women gave birth accompanied in more than 80% of vaginal births and in less than 35% of caesarean sections. Six out of ten women would have liked to be asked about the MOB of choice. In three hospitals, the preference for vaginal birth (VB) was more than 90% and in two, 67%. Preference for MOB was strongly associated with the hospital in which the birth took place. The reasons for preferring a VB included faster recovery, feeling ready, and considering it more natural, while the disadvantages reported included birth pain and not getting anaesthesia. The most frequent reason for preferring a CS was to avoid birth pain. Women in hospitals with lower preference for VB expressed safety as a CS advantage. The disadvantages of a CS included post-procedure pain, dependence on others to take care of her or the baby afterwards and prolonged time in the hospital compared to a VB. Conclusions: Women giving birth in public hospitals in Argentina prefer VB. Safety emerged as a theme in hospitals in which women had less preference for VB. Women’s accounts indicate the need to improve access to holistic pain management during VB as well as to participate women in their desirable MOB. Trial registration: IS002316 Abstract in additional language.Spanish Introducción: Las tasas de cesárea continúan aumentando en Latinoamérica. El diseño de intervenciones no clínicas para reducir cesáreas innecesarias requiere incorporar las preferencias de las mujeres sobre modalidad de parto preferida (MDP). Métodos: El estudio se realizó en cinco hospitales públicos en Argentina a través de un diseño mixto. Las mujeres fueron entrevistadas después del parto durante 8 semanas durante el año 2019. Les preguntamos su MDP preferida, las ventajas y desventajas de cada modalidad y el acompañamiento durante el parto. Las respuestas se codificaron y se analizaron cuantitativamente. Analizamos si las preferencias variaban según variables de las mujeres o de los hospitales. ResultadosLos cinco hospitales participantes reportaron limitado acceso a anestesia epidural. Participaron 621 mujeres, edad media 26 +6, 40% con cesárea previa. El 80% tuvo acompañamiento durante el parto vaginal (PV) y menos del 30% durante la cesárea. Seis en 10 mujeres hubieran preferido que les preguntaran sobre sus preferencias de parto. En tres hospitales el 90% de las mujeres prefiere PV y en dos hospitales el 67% prefiere un PV. La preferencia por la MD se asoció solamente al hospital en donde ocurrió el parto. Las razones de la preferencia por PV fueron recuperación más rápida y sentirse más preparadas. La razón más frecuente para preferir una cesárea fue la de evitar el dolor de parto y las desventajas se centraron en el dolor postoperatorio, la falta de independencia durante el postparto y el tiempo prolongado en el hospital.Conclusiones Las mujeres en hospitales públicos en Argentina prefieren el PV sobre la cesárea, pero con diferencias entre hospitales, indicando la necesidad de adaptar intervenciones. Debemos trabajar para mejorar el manejo del dolor de parto, garantizar el acompañamiento en cesáreas e incorporar las preferencias de las mujeres en la decisión del MP.