Factors related to the decision making process of primigravid women about mode of delivery: A theory-based study

Document Type : Original Article


1 Assistant professor, Department of Midwifery, School of Nursing and Midwifery, Gonabad University of Medical Sciences, Gonabad, Iran.

2 Assistant professor, Department of Health Education and Health Promotion, School of Health, Qom University of Medical Sciences, Qom, Iran.

3 M.Sc. of Mother and Child Health, Health Center Number Three, Mashhad University of Medical Sciences, Mashhad, Iran.

4 B.Sc. of Midwifery, Student Research Committee, School of Nursing and Midwifery, Gonabad University of Medical Sciences, Gonabad, Iran.


Introduction: The rate of cesarean section in Iran is three times higher than standard and attention to the factors affecting decision making process of women to choose mode of delivery helps to recognize the causes of its high rate. This study was performed with aim to investigate the factors affecting decision making process of women to choose mode of delivery based on the Health Belief Model (HBM).
Methods: This cross-sectional study was performed on 321 primigravid women who had normal and healthy pregnancy with gestational age of higher than 26 weeks in Gonabad from June 2014 to April 2017. Data collection tools included the questionnaire of personal and reproduction characteristics, the questionnaire of awareness about the advantages and disadvantages of vaginal delivery and cesarean section, the questionnaire of assessing HBM, and the questionnaire of choosing the mode of delivery. Data was analyzed by SPSS software (version16). P<0.05 was considered significant.
Results: 238 women (74.1%) had selected vaginal delivery and 83 (25.9%) cesarean. Among the HBM constructs, two groups were significantly different in terms of perceived susceptibility (p= 0.023) and perceived benefits (p= 0.001), but there was no significant difference between two groups in terms of knowledge, perceived severity and perceived barriers (p>0.05). Two groups were not significantly different in terms of age, education and occupation of pregnant women (p> 0.05), but a significant difference was found between those who had selected vaginal delivery and those who had selected cesarean in terms of sources of information about delivery mode (p= 0.008). 
Conclusion: The main findings of this study showed a relationship between perceived susceptibility and perceived benefits with intended mode of delivery. This finding can be used in designing educational programs for pregnant women with more emphasis on significant structures of HBM.


  1. Jarineshin H, Fekrat F, Kashani S. The Effect of paracetamol versus meperidine on postoperative pain of cesarean section. Anesth Essays Res 2017; 11(1):165-8.
  2. Betrán AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol 2007; 21(2):98-113.
  3. He Z, Cheng Z, Wu T, Zhou Y, Chen J, Fu Q, et al. The costs and their determinant of cesarean section and vaginal delivery: an exploratory study in chongqing municipality, China. Biomed Res Int 2016; 2016:5685261.
  4. Dadipoor S, Alavi A, Safari Moradabadi A. A survey of the growing trend of caesarian section in Iran and the world: a review article. Iran J Obstet Gynecol Infertil 2016, 19(27):8-17.
  5. The server encountered an internal error that prevented it from fulfilling this request. HTTP Status. Available at: URL: http://www.behdasht.gov.ir/index.jsp?fkeyid=&siteid=1&pageid=127&newsview=157345; 2006.
  6. Hildingsson I, Radestad I, Rubertsson C, Waldenström U. Few women wish to be delivered by caesarean section. BJOG 2002; 109(6):618-23.
  7. Marx H, Wiener J, Davies N. A survey of the influence of patients' choice on the increase in the caesarean section rate. J Obstet Gynaecol 2001; 21(2):124-7.
  8. Rahimikian F, Mirmohamadaliei M, Mehran M, Aboozari K, Barough S. Effect of education designed based on health belief model on choosing delivery mode. Hayat 2009, 14(3-4):25-32. (Persian).
  9. Ilika F, Jamshidimanesh M, Hoseini M, Saffari M, Peyravi H. An evaluation of high-risk behaviors among female drug users based on Health Belief Model. J Med Life 2015; 8(Spec Iss 3):36-43.
  10. Glanz K, Rimer BK, Viswanath K. Health behavior and health education: theory, research, and practice. 4th ed. San Francisco: John Wiley & Sons; 2008. P. 12-71.
  11. Taghdisi M, Nejadsadeghi E. Evaluation of knowledge, attitude and health behaviour of the pregnant women consulted in Behbahan Health Centers in the field of urinary infections based on the health belief model (hbm) (2010). Modern Care J 2011; 8(3):143-51. (Persian).
  12. Vakili MM, Hidarnia AR, Niknami SH, Mousavinasab SN. Effect of communication skills training on health belief model constructs about AIDS in Zanjan health volunteers (2010-11). ZUMS J 2011; 19(77):78-93. (Persian).
  13. Keesee M, Ahmad AS, Nelson W, Barney DD, Duran ES. An application of borrayo's cultural health belief model to HIV/AIDS seropositive hispanics living along the US/Mexico border. J HIV AIDS Soc Ser 2004; 3(3):9-34.
  14. Baghianimoghadam MH, Baghianimoghadam M, Jozi N, Hatamzadah N, Mehrabbik A, Hashemifard F, et al. The relationship between HBM constructs and intended delivery method. J Toloo-e-Behdasht 2014, 12:105-16.
  15. Kanani S, Allahverdipour H. Self-Efficacy of choosing delivery method and labor among pregnant women in Pars-Abad city. J Educ Community Health 2014; 1(2):39-47.
  16. Akbari N, Majlesi M, Rakhshani F, Montazeri A. Knowledge and attitude of pregnant women towards mode of delivery in Tehran, Iran. Payesh 2017, 16(2):211-8. (Persian).
  17. Zamani-Alavijeh F, Shahry P, Kalhory M, Haghighizadeh M, Sharifirad G, Khorsandi M. Identification of factors related to elective cesarean labor: a theory-based study. Sci Res J Shahed Univ 2012, 19(96):1-11.
  18. Loke AY, Davies L, Li SF. Factors influencing the decision that women make on their mode of delivery: the Health Belief Model. BMC Health Serv Res 2015; 15(1):274.
  19. Afshari A, Ghafari M. A survey on selection of delivery method by nulliparous pregnant women using health belief model in Semirom, Iran, 2012. Iran J Obstet Gynecol Infertil 2013, 16(47-48):22-9. (Persian).
  20. Pakenham S, Chamberlain SM, Smith GN. Women's views on elective primary caesarean section. J Obstet Gynaecol Canada 2006; 28(12):1089-94.
  21. Fuglenes D, Oian P, Kristiansen IS. Obstetrician's choice of cesarean delivery in ambiguous cases: is it influenced by risk attitude or fear of complaints and litigation? Am J Obstet Gynecol 2009; 200(1):48.e1-8.
  22. Negahban T, Ansari Jaberi A, Kazemi M. Preference methods of delivery and its relevant causes in view of pregnant women referring to public and private clinics in Rafsanjan city. J Rafsanjan Univ Med Sci 2006; 5(3):161-8. (Persian).
  23. Biglarifar F, Veisani Y, Delpisheh A. Women's knowledge and attitude towards choosing mode of delivery in the first pregnancy. Iran J Obstet Gynecol Infertil 2015; 17(13):19-24. (Persian).
  24. Farajzadegan Z, Ramazani M, Forughi A, Kelishadi M, Keypour M, Keypor M. Does cesarean section compromise mother's mental health? Iran J Nurs Midwifery Res 2009; 14(2):89-94.
  25. Bushehr IH, Bushehr IG, Student Research Committee, Student Research Committee. Assessing the factors influencing delivery method selection in pregnant women referred to Public hospitals in Shiraz. Adv Nurs Midwifery 2013, 23(81):13-8.
  26. Ziaghm S, Bakhshandeh Bavarsad M, Haghighi S, Sayhi M, Zargar-Natage M, Abadian S. Assessment of educational needs in pregnancy to choose the mode of delivery for nulliparous women. Nurs Dev Health 2014; 4(6-7):31-40. (Persian).
  27. Abdolkarimy M, Zareipour MA, Rezaie Moradali M, Mahmoodi H, Movahed H, Alinejad M. Prediction of delivery type based on the theory of planned behaviors. Nurs J Vulnerable 2016, 3(7):47-58. (Persian).
  28. Alimohamaian M, Shariat M, Mahmoodi M, Ramezanzadeh F. The influence of maternal request on the elective cesarean section rate in maternity hospitals in Tehran, Iran. Payesh 2003; 2(2):133-9. (Persian).
  29. Emmett CL, Shaw AR, Montgomery AA, Murphy DJ; DiAMOND study group. Women's experience of decision making about mode of delivery after a previous caesarean section: the role of health professionals and information about health risks. BJOG 2006; 113(12):1438-45.