A longitudinal observational study of preference for elective caesarean section among nulliparous Hong Kong Chinese women


Dr TN Leung, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR. Email dannytnleung@cuhk.edu.hk


Objective  To establish whether women’s preference for elective caesarean section (ELCS) changes as gestation advances.

Design  A prospective longitudinal observational study.

Setting  Two units providing obstetric care in Hong Kong, one public and one private.

Sample  Five hundred and one nulliparous Chinese pregnant women attending their routine fetal anomaly scan in either unit.

Methods  Consented subjects had two interviews using a structured questionnaire at 18–22 weeks and 35–37 weeks of gestation, respectively. Multivariate analysis was performed to identify determinants for preferring ELCS at the two gestational ages.

Main outcome measure  The preferences for the mode of delivery at the two gestational ages.

Results  The prevalence of maternal preference for ELCS in the study cohort was 17.2% (95% CI 13.9–20.5) and 12.7% (95% CI 9.6–15.8) at mid-trimester and at term, respectively. Significantly more women who preferred ELCS at mid-trimester changed to a trial of vaginal delivery (VD) at term than vice versa (42.0 versus 3.8%). The partner’s preference for ELCS was a significant determinant for women preferring ELCS throughout the antenatal period. Among the women booked in the public sector, more women who preferred ELCS at term changed to deliver in private hospitals than those who preferred VD (46.2 versus 9.7%).

Conclusions  Many women changed from preferring ELCS to preferring VD as their pregnancy approached term. The partner’s preference was a significant determinant for the women’s choice. If a decrease in the proportion of women preferring ELCS is desired, the intervention programme should target the women and their partners who hold such a preference at 20 weeks.