Open Access Open Badges Research article

Cesarean section in Shanghai: women’s or healthcare provider’s preferences?

Wei Deng12, Reija Klemetti3, Qian Long4, Zhuochun Wu13*, Chenggang Duan1, Wei-Hong Zhang56, Carine Ronsmans7, Yu Zhang1 and Elina Hemminki3

Author Affiliations

1 School of Public Health, Fudan University, 138 Yi Xue Yuan Road, P.O. Box 250, Shanghai 200032, China

2 Key Laboratory of Public Health Safety, Ministry of Education (Fudan University), Shanghai, China

3 National Institute for Health and Welfare, Helsinki, Finland

4 Global Health Research Center, Duke Kunshan University, Kunshan, China

5 International Centre for Reproductive Health, Ghent University, Ghent, Belgium

6 School of Public Health, Université libre de Bruxelles (ULB), Brussels, Belgium

7 London School of Hygiene and Tropical Medicine, London, UK

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BMC Pregnancy and Childbirth 2014, 14:285  doi:10.1186/1471-2393-14-285

Published: 22 August 2014



Cesarean section (CS) rate has increased rapidly over the past two decades in China mainly driven by non-medical factors. This study was to compare recalled preferences for CS among first-time mothers in early and late pregnancy with actual delivery mode; to explore factors related to CS preference and CS performed without medical indications; and to consider the role of healthcare providers in delivery mode preferences.


An anonymous questionnaire survey, combined with data on CS indications taken from the patient record, was conducted among 272 first-time mothers having their first postnatal check-up in one university affiliated obstetrics and gynecology hospital in Shanghai, China, between September 2006 and January 2007. Logistic regression was used to study factors related to the recalled preference for CS and CS performed without medical indication, adjusting for maternal age, education and income.


The CS rate was 57% (151/263) among all women, 17% with medical indications and 40% without medical indications. For women without medical indications for CS (n = 215), there was no significant difference between women’s preference for CS in early (25%) and late pregnancy (28%); 48% of women actually had CS. Women recalled preferring a vaginal delivery but who had CS were more likely to have had a CS suggested by a prenatal care doctor [OR (95% CI): 20 (3.88-107.1)] or by a delivery obstetrician [OR (95% CI): 26 (6.26-105.8)]. Among women recalled preferring and having CS, a suggestion from the prenatal care doctor to have CS was very common.


In the primiparous women without a medical indication for CS, women recall of a provider suggestion for CS was a strong predictor of CS both among women who recalled a preference for CS and among women who recalled a preference for vaginal delivery. Public health education needs strengthening, including discussion of the risks associated with CS and psychological and social support given to women to help them prepare for and cope with childbirth.

Cesarean section; Clinical indications; Delivery mode preference; Healthcare provider’s suggestion; Urban China