Sociodemographic factors and pregnancy events associated with women who declined vaginal birth after cesarean section.

Objective: Certain sociodemographic characteristics and pregnancy events were shown to pre-dispose women to decline vaginal birth after cesarean section (CS) in the Western population. The study aimed to identify the sociodemographic factors and pregnancy events associated with Chinese women who declined to attempt vaginal birth after CS.

Study Design: This was a retrospective study of Hong Kong Chinese women who delivered in a public obstetric unit between 2002 and 2006. It was the unit's policy that women should attempt vaginal birth after one previous lower segment CS. During the study period, 1317 healthy Hong Kong Chinese women carrying a singleton pregnancy had had one previous lower segment CS. Of these women, 787 had had no antenatal complications during their index pregnancy. Univariate and multivariate analyses were performed to identify the sociodemographic factors and pregnancy events associated with women who declined vaginal birth after CS.

Results: Thirty-nine percent (39.26%; 95%CI 35.85, 42.67) of women had elective CS because they had declined a vaginal birth. A history of a previous successful vaginal birth was the strongest determinant negatively associated with declining a vaginal birth (OR 0.15; 95%CI 0.06, 0.37). Determinants that were positively associated with declining a vaginal birth were higher family social class (OR 1.61; 95%CI 1.02, 2.55); family income of more than US$ 3850 per month (OR 1.56; 95%CI 1.03, 2.34), and women who attended private antenatal care before their first visit to the public unit (OR 1.47; 95%CI 1.02, 2.12).

Conclusions: Women who experienced a previous successful vaginal birth were positively associated with attempting vaginal birth after CS. Women who declined vaginal birth after CS exhibited certain social characteristics and treatment-seeking behavior. Future studies into the social context of this group of women may help us understand the underlying reasons why they decline vaginal birth.