A Study of the Factors Influencing Women's Decision about Childbirth

描述（由申请人提供）：目前剖宫产（CS）的使用率是世界卫生组织（CDC，2006）推荐的两倍以上;在过去二十年中，由于尚不清楚的原因，该程序的使用几乎翻了一番。过度使用导致本可避免的发病率和死亡率以及与分娩有关的更高的保健费用。人们提出了CS使用增加的许多原因，包括“产妇要求”数量的增加-健康妇女在没有医学指征的情况下要求CS。美国国立卫生研究院的一个专家小组探讨了产妇的剖宫产要求，并得出结论认为，目前没有足够的证据证明产妇在没有医学指征的情况下要求剖宫产，并建议“增加对预测和影响阴道分娩成功可能性的策略的研究”（美国国立卫生研究院，2006年，第20页）。使用相同的数据，美国妇产科学会（ACOG）得出结论，只要她是消息灵通的，就没有理由拒绝对健康母亲进行手术分娩（ACOG，2003）。这些立场之间的分歧点的关键差距知识的因素，驱动CS率，包括产妇的需求对使用CS的影响。尽管最近对产妇需求的关注，但很少有关于妇女希望从分娩经历中得到什么的研究，包括她们选择一种分娩方式而不是另一种分娩方式的原因。我们所提出的研究的目的是回答这个问题：什么因素会影响妇女对如何生孩子的决定？妇女对第一次生育的希望和愿望受到她们所知道的东西的影响-有意识和无意识地。由于人们只是部分意识到的态度和信念，告知他们的希望和愿望，这一建议将使用三种方法收集数据。第一种是社会科学中常用的投射方法，用于获取存在于意识之外的知识。第二种是焦点小组方法，为分娩妇女提供了一个场所，使她们能够清楚地表达自己关于分娩的想法，并允许参与者将自己的想法与他人进行比较。第三，所有的妇女将在婴儿出生后接受采访，以了解她们的经历如何影响妇女未来的生育选择。参与者将是50名年龄在21岁或21岁以上的无并发症妊娠的孕妇。这项建议建立在研究人员以前与CS使用相关的工作基础上。这是一个明确的研究方案的一步，该方案旨在通过优化怀孕、分娩和分娩期间的护理来改善母亲及其子女的健康。公共卫生相关性：该项目的重点是了解妇女希望从分娩经历中得到什么，以及她们选择分娩方式的依据。如果我们要了解母体需求在使用CS中的作用，这些知识是必不可少的。我们的数据将为公共卫生政策提供信息，这些政策既涉及支持产妇选择，又涉及通过减少与分娩相关的风险来确保长期的母婴健康。这项研究是一个系统的研究计划的一部分，致力于改善妇女的健康和满意度与他们的分娩经验。

DESCRIPTION (provided by applicant): Abstract Cesarean section (CS) is currently used at over twice the rate recommended by the World Health Organization (CDC, 2006); use of the procedure has almost doubled in the last two decades for reasons that are as yet poorly understood. Overutilization results in avoidable morbidity and mortality and higher health costs related to childbirth. Many causes for the increased use of CS have been suggested, including growth in the number of "maternal requests" -- healthy women asking for CS in the absence of medical indications. An NIH expert panel explored maternal request CS and concluded that at this time there is insufficient evidence to warrant CS on maternal demand without medical indications and recommended "increased research devoted to strategies to predict and influence the likelihood of successful vaginal birth" (NIH, 2006, p. 20). Using the same data, the American College of Obstetrics and Gynecologists (ACOG) concluded that there is no reason to deny a surgical birth to a healthy mother as long as she is well-informed (ACOG, 2003). The divergence between these positions points to a critical gap in knowledge about the factors that drive CS rates, including the influence of maternal demand on the use of CS. Despite this recent focus on maternal demand, there is scant research on what women want from their birthing experience, including their reasons for choosing one mode of childbirth over another. The purpose of our proposed research is to answer the question: what factors influence women's decisions about how their babies will be born? Women's hopes and desires for their first birth experience are influenced by what they know - both consciously and unconsciously. Because people are only partly aware of the attitudes and beliefs that inform their hopes and desires, this proposal will use three methods of data collection. The first is a projective method commonly used in the social sciences to access knowledge that exists outside of consciousness. The second is a focus group method that provides a venue for birthing women to articulate the conscious basis for their ideas about childbirth and allow participants to compare their ideas with others. Third, all women will be interviewed after the baby is born to build understanding about how their experiences influence future birthing choices the women make. Participants will be 50 primigravid women with uncomplicated pregnancies aged 21 or older. This proposal builds on the researchers' previous work related to the use of CS. It is one step in a defined program of research directed towards improving the health of mothers and their children by optimizing care during pregnancy, labor and birth. PUBLIC HEALTH RELEVANCE: This project in focused on building knowledge about what women want from their birthing experience and what informs their choices about mode of birth. This knowledge is essential if we are to understand the role of maternal demand in use of CS. Our data will inform public health policy concerned with both supporting maternal choice and ensuring long term maternal- child health by reducing the risks associated with childbirth. This study is part of a systematic program of research dedicated to improving women's health and satisfaction with their birthing experience.