ArticleFrontiers in medicine2025
Psychological predictors of cesarean delivery on maternal request in upper middle-income settings and the mitigating role of prenatal psychological education: a multicenter longitudinal study.
Article in Frontiers in medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: This study aimed to investigate, in an upper middle-income country context, the impact of maternal psychological status and prenatal psychological education on the cesarean delivery on maternal request among primiparous women. Methods: This prospective longitudinal study included 948 primiparous women who delivered at five hospitals between June 2023 and June 2024. Women with medical indications for cesarean section, multiparity, or incomplete data were excluded. Maternal anxiety and depression were assessed in the first, second, and third trimesters using the Self-Rating Anxiety Scale and Self-Rating Depression Scale. Childbirth fear was evaluated in the third trimester using the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ). Multivariate logistic regression was used to examine factors associated with cesarean delivery on maternal request. Results: Among the 948 participants, 543 (57.3%) had vaginal deliveries, while 405 (42.7%) underwent cesarean delivery on maternal request. Third-trimester anxiety, depression, and W-DEQ scores were significantly higher in the cesarean group ( Conclusion: Maternal psychological distress and fear of childbirth are significant contributors to the decision for cesarean delivery on maternal request among primiparous women. In an upper middle-income country context, prenatal psychological education may serve as an effective intervention to reduce childbirth fear and promote informed, evidence-based delivery decisions. Integrating routine mental health screening and targeted education into antenatal care could help curb the rising trend of unnecessary cesarean deliveries.
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