Document Type : Original Article
Authors
- . Ali Safari‑Moradabadi
- . Azin Alavi 1
- . Asiyeh Pormehr‑Yabandeh 2
- . Tasnim Eghbal Eftekhaari 3
- . Sakineh Dadipoor 2
1 Fertility and Infertility Research Center, Faculty of Medicine, Hormozgan University of Medical Sciences
2 Mother and Child Welfare Research Center, Faculty of Public Health, Hormozgan University of Medical Sciences
3 Molecular Medicine Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
Abstract
BACKGROUND: Mortality and disability rates were reported to be respectively 2‑3 and 5‑10 times
higher in C‑sections compared to Vaginal delivery.
OBJECTIVES: This study was aimed to explore the factors involved in selecting the birth type among
primiparous women.
METHODS: The present cross‑sectional research was conducted on 220 primiparous women,
who visited the health‑care centers of Bandar Abbas. They were recruited in their first trimester of
pregnancy with a simple randomized clustering method. Data were collected in a researcher‑designed
questionnaire. Its validity was confirmed by a panel of experts and reliability was tested and approved
through the test–retest method. Mean, standard deviation, independent sample t‑test, and Chi‑squared
tests for data analysis were done by SPSS 16. P < 0.05 was considered statistically significant.
RESULTS: The mean age of the participants was 27.40 ± 6.07 years. The main barriers to the choice
of vaginal delivery were the fear of pain and fear of vaginal area tears and ruptures, fear of injury to
fetus, and doctor’s recommendation. A statistically significant correlation was observed between the
age, education, employment, income, awareness, and the reasons for preferring surgical childbirth.
CONCLUSIONS: To reduce the rate of unnecessary cesarean sections (C‑section), the following
recommendations are suggested: Reducing fear of pain in expectant mothers, modifying wrong
beliefs about the culture of natural childbirth, increasing awareness of fewer adverse effects of
vaginal delivery including the vaginal tears if the mother abides by all midwife(s) instructions during
the delivery procedure, providing educational courses for the necessary movements during the
delivery, decreasing surgeons’ payment for C‑section, and increasing payment for natural childbirth
and implementing barriers for optional delivery to reduce the C‑section.
Keywords
delivery and policies to increase it from the point of view of
gynecologists and midwives. J Health Dev 2016;5:71‑8.
2. Safari‑MoradabadiA, MehrabanM, AlaviA, Pormehr‑YabandehA,
Ghiaspour T, Dadipoor S. Investigating the delivery type among
primiparous women in Bandar Abbas according to the health
belief model. Middle East J Fam Med2018;7(10):121.
3. Safari Moradabadi A, Alavi A, Eqbal Eftekhaari T, Dadipoor S.
The reproductive behavior of families with thalassemic children
in hormozgan. J Reprod Infertil 2015;16:167‑70.
4. Dadipoor S, Alavi A, Safari‑Moradabadi A. A survey of the
growing trend of caesarian section in Iran and the world: Areview
article. Iran J Obstet Gynecol Infertil 2016;19:8‑17.
5. DadipoorS, AghamolaeiT, RamezankhaniA, Safari‑MoradabadiA.
Comparison of health belief model constructs according to birth
type by nulliparous pregnant women in bandar abbas. J Educ
Community Health 2017;4:65‑71.
6. Safari Moradabadi A, Hassani L, Ghanbarnejad A, Madani A,
Rajaei I, Dadipoor S. The effect of education on knowledge and
preferred method of delivery in nulliparous women. J Health
Care 2014;16:74‑83.
7. Zarei E, Majidi S, Bay V. Achievement of health sector evolution
objectives in the vaginal delivery promotion plan: A study in a
large public hospital in Tehran. J Health Field 2017;3:27‑32.
8. Alimohammadzadeh K, Mohebi S, Labaf T. Systematic review
of research papers in the recent three decades on the” reasons of
cesarean section” and population health management strategies
in Iran. Womens Strateg Stud 2013;16:8‑57.
9. BushehrIH, BushehrIG, Committee SR, Committee SR. Assessing
the Factors Influencing Delivery Method Selection in Pregnant
Women Referred to Public Hospitals in Shirazr; 2014.
10. Boskabadi H, Zakerihamidi M, Bagheri F. Outcomes of vaginal
delivery and cesarean in Mashhad Ghaem University Hospital.
Tehran Univ Med J TUMS Publ 2014;71:807‑15.
11. Dadipoor S, Safari Moradabadi A, Esmaeelion F,
Eghbal Eftekhaari T, Alavi A, Fallahi S, et al. Prevalence of legal
abortions and correlated causes in a central women’s hospital in
South of Iran (2009‑2012). Life Sci J 2013; 10(12s):91‑4.
12. Faraji Darkhaneh R, Zahiri Sooroori Z, Farjad Bastani F. A survey
of knowledge and attitude of pregnant women about delivery
methods. J Guilan Univ Med Sci 2003;12:69‑75.
13. Bick D; National Collaborating Centre for Women’s and
Children’s Health, National Institute for Clinical Excellence.
Caesarean section. Clinical guideline. National collaborating
centre for women’s and children’s health: Commissioned by the
national institute for clinical excellence. Worldviews Evid Based
Nurs 2004;1:198‑9.
14. Ghadimi M, Rasouli M, Motahar S, Lajevardi Z, Imani A,
Chobsaz A, et al. Affecting factors the choice of delivery and
attitude of pregnant women admitted to the civil hospitals, the
Social Security Organization in 2013. J Sabzevar Univ Med Sci
2014;21:310‑9.
15. Saisto T, Halmesmäki E. Fear of childbirth: A neglected dilemma.Acta Obstet Gynecol Scand 2003;82:201‑8.
16. Abad M. Elective Caesarean; Ethical or non‑Ethical a Approach?
Medical Ethics Journal. 2016;3(8):103‑25.
17. Bani S, Seyedrasooli E, Shams GT, Ghoojazadeh M,
Hassanpoor S. Preference of delivery attendants regarding
mode of delivery for themselves and pregnant women. Payesh
2012;11:629‑35.
18. Azizi M, Salari P. Ethical approach in cesarean delivery by
maternal request. Iran J Med Ethics Hist Med 2009;2:55‑66.
19. Tabandeh A, Kashani E. The prevalence of cesarean among
employed educated women of medical science groups in Gorgan,
2005. J Gorgan Univ Med Sci 2007;9:67‑70.
20. Zasloff E, Schytt E, Waldenström U. First time mothers’ pregnancy
and birth experiences varying by age. Acta Obstet Gynecol Scand
2007;86:1328‑36.
21. Eynsheykh ZD, Shaahmadi F, Taslimi S, Emamiureh F,
Moeinaldini S. Investigating the relationship between
demographic factors and choice of delivery method in pregnant
women in the city of Savojbolagh. J Family Reprod Health
2013;7:35‑8.
22. Mohammadbeygi A, Tabatabaei S, Mohammad SN, Yazdani M.
Factors influencing cesarean delivery method in Shiraz hospitals.
Iran J Nurs 2009;21:37‑45.
23. Gould JB, Davey B, Stafford RS. Socioeconomic differences in
rates of cesarean section. N Engl J Med 1989;321:233‑9.
24. Reza Soltani P, Hosseinjani A, Etebari S. Causes of cesarean
section performed in an educational health care center. J Holist
Nurs Midwifery 2012;22:16‑22.
25. Karlström A, Rådestad I, Eriksson C, Rubertsson C, Nystedt A,
Hildingsson I. Cesarean section without medical reason, 1997 to
2006: A Swedish register study. Birth 2010;37:11‑20.
26. Alimohamadian M, Shariat M, Mahmoodi M, Ramezanzadeh F.
The influence of maternal request on the elective cesarean section
rate in maternity hospitals in Tehran. Iran Payesh 2003;2:133‑9.
27. Ziaghm S, Bakhshandeh Bavarsad M, Haghighi S, Sayhi M,
Zargar‑Natage M, Abadian S. Assessment of educational needs
in pregnancy to choose the mode of delivery for nulliparous
women. Nurs Dev Health Aligoodarz Nurs Faculty Analytic Res
J 2014;3:31‑40.
28. Leone T, Padmadas SS, Matthews Z. Community factors affecting
rising caesarean section rates in developing countries: An analysis
of six countries. Soc Sci Med 2008;67:1236‑46.
29. Vafaee R, Hosseini F, Dashdebi K, Momen Bellah Fard MJ,
GhalandariM, GharlipourZ, et al. Assessing the factors influencing
delivery method selection in pregnant women referred to public
hospitals in Shirazr. J Nurs Midwifery 2013;81:13‑8.
30. Chong ES, Mongelli M. Attitudes of Singapore women
toward cesarean and vaginal deliveries. Int J Gynaecol Obstet
2003;80:189‑94.
31. Garmaroudi G, Eftekhar H, Batebi A. Study of risk factors for
cesarean section in pregnant women. Payesh 2012;1:45‑9.
32. GhahfarokhiZ, Khalajabadi F, Saraei H. Determinants of intention
for cesarean section vs. normal delivery among pregnant women
in Esfahan. J Popul Assoc Iran 2016;9:199‑224.
33. Mohammadi TS, Kiani AA, Heydari M. The survey on tendencies
of primiparous women for selecting the mode of delivery. J Babol
Univ Med Sci 2009;11:54‑9.
34. Béhague DP, Victora CG, Barros FC. Consumer demand for
caesarean sections in Brazil: Informed decision making, patient
choice, or social inequality? A population based birth cohort
study linking ethnographic and epidemiological methods. BMJ
2002;324:942‑5.
35. Klemetti R, Che X, Gao Y, Raven J, Wu Z, Tang S, et al. Cesarean
section delivery among primiparous women in rural China: An
emerging epidemic. Am J Obstet Gynecol 2010;202:65.e1‑6.
)