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Impact of first childbirth on changes in women's preference for mode of delivery: Follow-up of a longitudinal observational study

机译：首次分娩对妇女偏爱分娩方式变化的影响：一项纵向观察性研究的随访

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Background: A woman's childbirth experience has an influence on her future preferred mode of delivery. This study aimed to identify determinants for women who changed from preferring a planned vaginal birth to an elective cesarean section after their first childbirth. Methods: This prospective longitudinal observational study involved two units that provide obstetric care in Hong Kong. A mail survey was sent to 259 women 6 months after their first childbirth. These women had participated in a longitudinal cohort study that examined their preference for elective cesarean section in the antenatal period of their first pregnancies. Univariate and multivariate analyses were performed to identify determinants for women who changed from preferring vaginal birth to elective cesarean section. Results: Twenty-four percent (23.8%, 95% CI 18.4-29.3) of women changed from preferring vaginal birth to elective cesarean section after their first childbirth. Determinants found to be positively associated with this change included actual delivery by elective cesarean section (OR 106.3, 95% CI 14.7-767.4) intrauterine growth restriction (OR 19.5, 95% CI 1.1-353.6), actual delivery by emergency cesarean section (OR 8.4, 95% CI 3.4-20.6), higher family income (OR 3.2, 95% CI 1.1-8.8), use of epidural analgesia (OR 2.6, 95% CI 1.0-6.8), and higher trait anxiety score (OR 1.1, 95% CI 1.0-1.3). The most important reason for women who changed from preferring vaginal birth to elective cesarean section was fear of vaginal birth (24.4%). Conclusions: A significant proportion of women changed their preferred mode of delivery after their first childbirth. Apart from reducing the number of cesarean sections in nulliparous women, prompt provision of education to women who had complications and investigations into fear factors during vaginal birth might help in reducing women's wish to change to elective cesarean section.
机译：背景：妇女的分娩经历对其未来的分娩方式有影响。这项研究旨在确定决定因素的女性，这些女性在首次分娩后从倾向于计划的阴道分娩改为择期剖宫产。方法：这项前瞻性纵向观察研究涉及两个在香港提供产科护理的部门。在第一例分娩后六个月向259名妇女发送了邮件调查。这些妇女参加了一项纵向队列研究，研究了她们在第一次怀孕的产前期对选择性剖宫产的偏爱。进行了单因素和多因素分析，以确定了从偏好阴道分娩改为选择性剖宫产的妇女的决定因素。结果：24％（23.8％，95％CI 18.4-29.3）的妇女在第一次分娩后从偏爱阴道分娩改为择期剖宫产。发现与这一变化呈正相关的决定因素包括选择性剖宫产的实际分娩（OR 106.3，95％CI 14.7-767.4）宫内生长受限（OR 19.5，95％CI 1.1-353.6），紧急剖宫产的实际分娩（OR 8.4，95％CI 3.4-20.6），家庭收入较高（OR 3.2，95％CI 1.1-8.8），使用硬膜外镇痛剂（OR 2.6，95％CI 1.0-6.8），性状焦虑评分较高（OR 1.1， 95％CI 1.0-1.3）。从偏爱阴道分娩改为择期剖宫产的妇女的最重要原因是害怕阴道分娩（24.4％）。结论：相当大比例的妇女在第一次分娩后改变了自己的分娩方式。除了减少未产妇剖宫产的数量外，对患有并发症的妇女进行及时的教育以及对阴道分娩期间的恐惧因素进行调查可能有助于减少妇女改选剖腹产的意愿。

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