• Mariam Khan Qamar Department of Pathology Foundation University Medical College, Rawalpindi
  • Babar Tasneem Shaikh Health Services Academy, Ministry of National Health Services, Regulations & Coordination, Islamabad http://orcid.org/0000-0002-2056-4132
  • Aamir Afzal Foundation University Medical College, Rawalpindi.
  • Armaghana Khan Qamar Pakistan Institute of Medical Sciences, Islamabad
  • Yumna Khan Qamar Combined Military Hospital, Rawalpindi


Background: In the wake of growing c- section rates around the developing world and likewise in Pakistan, there is paucity of knowledge about the preference of Pakistani women for the mode of delivery. Therefore, this study explored the reasons behind their preference. Methods: A cross-sectional study was conducted with a non-probability consecutive sampling technique including 232 pregnant women. Results: Majority (87.5%) would prefer a vaginal delivery because it is the natural way of giving birth and its recovery is faster. Moreover, women perceive that it would be easier to provide immediate care and breastfeeding to the newborn. Fear of surgery was the main deterrent for a c-section. Nonetheless, there were 12.5% women in favour of caesarean section, among whom a majority feared birth trauma to the newborn, labour pain, or complications of vaginal delivery such as possible faecal or urinary incontinence. Conclusion: Pakistani women at large prefer a normal vaginal delivery and therefore the rising trends of c- section cannot be attributed to the demand of the expecting women. Hence, there is a need for elucidating and explicating the real and perhaps the undisclosed reasons for the rising rates of caesarean section as a mode of delivery in Pakistan.


Betrán AP, Ye J, Moller AB, Zhang J, Gülmezoglu AM, Torloni MR. The increasing trend in caesarean section rates: global, regional and national estimates: 1990-2014. PLoS One 2016;11(2):e0148343.

Belizán JM, Minckas N, McClure EM, Saleem S, Moore JL, Goudar SS, et al. An approach to identify a minimum and rational proportion of caesarean sections in resource-poor settings: a global network study. Lancet Glob Health 2018;6(8):e894-e901.

Long Q, Kingdon C, Yang F, Renecle MD, Jahanfar S, Bohren MA, et al. Prevalence of and reasons for women’s, family members’, and health professionals’ preferences for cesarean section in China: A mixed-methods systematic review. PLoS Med 2018;15(10):e1002672.

Stjernholm YV, Petersson K, Eneroth E. Changed indications for cesarean sections. Acta Obstet Gynecol Scand 2010;89(1):49–53.

Betrán AP, Torloni MR, Zhang JJ, Gülmezoglu AM. WHO statement on caesarean section rates. BJOG 2016;123(5):667–70.

Lumbiganon P, Laopaiboon M, Gülmezoglu AM, Souza JP, Taneepanichskul S, Ruyan P, et al. World Health Organization Global Survey on Maternal and Perinatal Health Research Group: Method of delivery and pregnancy outcomes in Asia 2007-08. Lancet 2010;375(9713):490–8.

Chong YS, Kwek KY. Safer childbirth: avoiding medical interventions for non-medical reasons. Lancet 2010;375(9713):440–2.

Akarsu RH, Mucuk S. Turkish women’s opinions about cesarean delivery. Pak J Med Sci 2014;30(6):1308–13.

Angeja AC, Washington AE, Vargas JE, Gomez R, Rojas I, Caughey AB. Chilean women’s preferences regarding mode of delivery: which do they prefer and why? BJOG 2006;113(11):1253–8.

Jeremiah I, Nonye-Enyidah E, Fiebai P. Attitudes of antenatal patients at a tertiary hospital in Southern Nigeria towards caesarean section. J Public Health Epidemiol 2011;3(13):617–21.

Schemann K, Patterson JA, Nippita TA, Ford JB, Roberts CL. Variation in hospital caesarean section rates for women with at least one previous caesarean section: a population based cohort study. BMC Pregnancy Childbirth 2015;15(1):179.

Ajeet S, Jaydeep N, Nandkishore K, Nisha R. Women’s knowledge, perceptions, and potential demand towards caesarean section. Natl J Community Med 2011;2(2):244–8.

Faisal I, Matinnia N, Hejar AR, Khodakarami Z. Why do primigravidae request caesarean section in a normal pregnancy? A qualitative study in Iran. Midwifery 2014;30(2):227–33.

Chu KH, Tai CJ, Hsu CS, Yeh MC, Chien LY. Women's preference for cesarean delivery and differences between Taiwanese women undergoing different modes of delivery. BMC Health Serv Res 2010;10(1):138.

Stoll K, Edmonds JK, Hall WA. Fear of childbirth and preference for cesarean delivery among young American women before childbirth: a survey study. Birth 2015;42(3):270–6.

Mazzoni A, Althabe F, Gutierrez L, Gibbons L, Liu NH, Bonotti AM, et al. Women’s preferences and mode of delivery in public and private hospitals: a prospective cohort study. BMC Pregnancy Childbirth 2016;16(1):34.

da Silva Charvalho P, Bittár MH, Stjernholm YV. Indications for increase in caesarean delivery. Reprod Health 2019;16(1):72.

Shaikh BT, Hatcher J, Haran D. Making healthcare systems more responsive to women in Pakistan. BMJ 2006;333(7575):971.

Ali Y, Khan MW, Mumtaz U, Salman A, Muhammad N, Sabir M. Identification of factors influencing the rise of cesarean sections rates in Pakistan, using MCDM. Int J Health Care Qual Assur 2018;31(8):1058–69.

National Institute of Population Studies & Macro International. Pakistan Demographic & Health Survey 2017-18. Islamabad: 2018.

Kosan Z, Kavuncuoglu D, Calıkoglu EO, Aras A. Delivery preferences of pregnant women: Do not underestimate the effect of friends and relatives. J Gynecol Obstet Hum Reprod 2019;48(6):395–400.

Siabani S, Jamshidi K, Mohammadi MM. Attitude of pregnant women towards Normal delivery and factors driving use of caesarian section in Iran (2016). Biopsychosoc Med 2019;13:8.

Azam S, Khanam A, Tirlapur S, Khan K. Planned caesarean section or trial of vaginal delivery? A meta-analysis. Curr Opin Obstet Gynecol 2014;26(6):461–8.

Walana W, Acquah EK, Vicar E, Muhiba A, Dedume J. Preference of birth delivery modes among women attending antenatal and postnatal clinics in the Tamale Metropolis of Ghana. J Preg Child Health 2017;4(297):2.

Aali BS, Motamedi B. Women's knowledge and attitude towards modes of delivery in Kerman, Islamic Republic of Iran. East Mediterr Health J 2005;11(4):663–72.

Lothian JA. Promoting, protecting, and supporting normal Birth. J Perinat Educ 2002;11(3):1–5.

Abbasi AU. Vaginal birth after cesarean section. J Ayub Med Coll Abbottabad 2012;24(3-4):1–2.

Yee LM, Kaimal AJ, Houston KA, Erica WU, Thiet MP, Nakagawa S, et al. Mode of delivery preferences in a diverse population of pregnant women. Am J Obstet Gynecol 2015;212(3):377.e1–24.

Maznin NLB, Creedy DK. A comprehensive systematic review of factors influencing women's birthing preferences. JBI Libr Syst Rev 2012;10(4):232–306.



Most read articles by the same author(s)

<< < 1 2