Research Article: Cesarean section in China, Taiwan, and Hong Kong—A safe choice for women and clinicians?

Date Published: October 16, 2018

Publisher: Public Library of Science

Author(s): Mairead Black, Sohinee Bhattacharya

Abstract: Mairead Black and Sohinee Bhattacharya discuss research findings on preferences for cesarean delivery in Asian settings and share their Perspective on facilitating woman-centered birth choices in China following the end of the one-child policy.

Partial Text: Maternal preference for CS assessed in early pregnancy played a minor part in explaining rising CS trends, as previously found in countries with high CS rates [4]. However, interactions with healthcare providers during pregnancy emerge as a contributor towards 1 in 5 women in the third trimester preferring a CS birth. A further proportion appears to be explained by decisions made by clinicians. In keeping with evidence from Turkey—where in 83.1% of cases women described a plan for CS as being their obstetrician’s decision—Long and colleagues identified that not only is CS perceived to reduce litigation risk but some clinicians in mainland China may be motivated to perform CS to increase financial revenue, even when this is in direct conflict with clinical guidance [5].

Long and colleagues found that belief in the ‘safety’ of CS birth underpinned women’s CS preferences in early pregnancy, not least when women felt they ‘had one chance to get it right’ under China’s one-child policy. Women–clinician relationships were critical to evolving CS choices during pregnancy, in which loss of faith in a provider due to a perceived lack of woman-centred care led to CS requests in a bid to avoid negative intrapartum experiences.

It is clear from the work of Long and others that China’s recent one-child policy has affected attitudes towards CS birth, and the end to the policy demands a fresh look at how future pregnancy and long-term outcomes of CS birth are studied and shared with women. Information about the cumulative and long-term risks and benefits of a planned CS across more than one pregnancy are sadly lacking. China is in a strong position to use its high CDMR rates and its population-based birth registries to support studies of birth outcomes beyond mortality and to engage with women to identify outcomes that are important to them. Such a truly woman-centred approach would facilitate birth choices being made in the full knowledge of the balance of risks and benefits.



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