Multiparous women prefer cesarean delivery, but why?

Multiparous women more often prefer cesarean delivery than women giving birth for the first time, but their preference is probably driven by factors such as previous cesarean or fear of delivery rather than parity itself, Norwegian researchers report.

In a cross sectional study based on the Norwegian Mother and Child Cohort study of 58,881 women, 6% of women favored cesarean over vaginal delivery. Among multiparous women, 5.1% strongly preferred cesarean delivery compared with 2.4% of nulliparous women. In the absence of potential predictors of preference, the probability that a woman would favor a cesarean delivery was less than 2% for both nulli- and multiparous women. When predictors such as previous cesarean, negative delivery experience, or fear of birth were present, the probability of a request for cesarean delivery ranged from 20% to 75%. The study was published March 28 online in the American Journal of Obstetrics and Gynecology.

“Although multiparous women expressed a preference for cesarean delivery more frequently than nulliparous women, the regression results indicated that it is not parity per se that drives this preference, but rather having had a cesarean delivery or a bad experience during a previous delivery,” the authors write. Socioeconomic status and general health had little effect on preference.

Women who had previously delivered by cesarean delivery had a 9.5% probability of requesting cesarean delivery in the current pregnancy. The probability increased to 20% to 40% when previous cesarean delivery was combined with either fear of birth or a previous negative delivery experience.

The researchers suggest that identifying risk factors such as these after the first delivery and intervening to address maternal concerns “could help avoid medically ‘unnecessary’ cesarean deliveries in future pregnancies.”