| Summary: | 碩士 === 國立陽明大學 === 社區護理研究所 === 95 === The rate of cesarean delivery is about 33% in the past few years in Taiwan, which was among the highest in the world. Few studies have been conducted on method of delivery and related knowledge and attitude. The objectives of this prospective study were to examine the effect of pregnancy and labor related knowledge and attitude during pregnancy on method of delivery among primiparas in Taiwan.
A total of 179 paimiparas were recruited at four clinics in Taipei area from February to July, 2006. A structured questionnaire was used to enquire pregnancy and labor related knowledge and attitude during 34 to 36 weeks of pregnancy. Method of delivery was obtained at one month after delivery. There were 20 and 6 items for knowledge and attitude, respectively. The rate of cesarean delivery was 31.3% and the rate of cesarean delivery by women’s demand as reported by our study women was 6.2%. The rates of correct answers to each knowledge question ranged from 15.6% to 96.1%, with mean number of correct items by each women being 11.1. The rate of answering “agree” to the attitudinal questions ranged from 34.1% to 97.8%, with mean number of “agree” items by each women being 3.5. The multivariate results showed that four knowledge items were related to method of delivery. Women who thought that cesarean delivery is more likely to cause infection than vaginal delivery were more likely to have a cesarean delivery (OR: 9.71, 95% CI: 2.03-46.47). Women who thought that pulmonary embolism was a potential life-threatening complication of cesarean delivery were more likely to have a cesarean delivery (OR: 5.82, 95% CI: 1.03-32.83). Women who thought that attachment between mother and child would be negatively influenced when mothers need to stay at hospital or recover for a longer period of time were less likely to have a cesarean delivery (OR: 0.22, 95% CI: 0.08-0.61). Women who thought that vaginal delivery was safer than cesarean delivery were less likely to have a cesarean delivery (OR: 0.32, 95% CI: 0.11-0.94). Two attitudinal variables were significantly related to method of delivery. Women who agreed that vaginal delivery carried more pain than cesarean delivery were less likely to have a cesarean delivery (OR: 0.33, 95% CI: 0.11-0.96). Women who agreed that vaginal delivery may cause incontinence in the future were more likely to have a cesarean delivery (OR: 3.16, 95% CI: 1.20-8.33). Other significant factors included spousal age, hospital level, and gender of the doctor. Women whose spouse was between 30 to 34 and over 35 years of age had a higher risk of cesarean delivery than under 29 years of age (OR: 44.88, 95% CI: 7.67-262.63 for 30-34 years of age; OR: 38.17, 95% CI: 5.82-250.33 for over 35 years of age). Women who delivered at a district hospital had a lower risk of cesarean delivery than those delivered at a medical center (OR: 0.13, 95% CI: 0.03-0.51). Male doctors were more likely to perform cesarean delivery (OR: 6.64, 95% CI: 1.37-32.30).
Our results suggested that labor-related knowledge was generally insufficient or incorrect among primiparas. Also they tended to believe that vaginal delivery was more painful, incontinence, more scary, and less likely to fit with personal and family lifestyle. Future intervention programs should involve spouses, increase women and spouses’ knowledge on method of delivery, justify exceeding safety expectations about cesarean delivery, and decrease anxiety and fear associated with vaginal delivery in order to decrease cesarean delivery.
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