Factors influencing decision-making to accept elective cesarean section
1Sania Ali, 2Uzma, 3Anam Mumtaz, 4Nawab Khatoon, 5Rubab, 6Hira maqsood, 7Raishem
1PG Trainee, PUMHS, OBGYN
2Gynecologist BPS 18, FCPS, PUMHS, OBGYN
3Senior Registrar M.S, GIMS, OBGYN
4WMO BPS 18, PUMHS, OBGYN
5PG Trainee (MS) MBBS, PUMHS, PEADS medicine
6Consultant, PUMHS, OBGYN
7associate Professor Fcps, Pumhs, Obgyn
Vol: 14/02
Submission: 05 December 2025 | Acceptance: 29 December 2025 | Publication: 14 January 2026
ABSTRACT
Background:
The rising trend of elective cesarean sections (CS) worldwide has generated concern regarding its non-medical determinants. Understanding the underlying factors guiding women’s preference for elective CS is essential to promote safe and evidence-based childbirth practices.
Objective:
This study aimed to identify and analyze socio-demographic, psychological, social, and provider-related factors influencing women’s decision-making to accept elective cesarean section at a tertiary care hospital.
Methodology:
A descriptive cross-sectional study was conducted at the Department of Obstetrics and Gynaecology, People’s University of Medical and Health Sciences (PUMHS), Nawabshah, from June 21 to December 20, 2024. A total of 100 third-trimester pregnant women, either undergoing or offered elective CS, were recruited through purposive sampling, excluding those with absolute indications. Data were collected using a structured questionnaire covering socio-demographic variables (age, education, socioeconomic status), obstetric history, psychological factors (fear of childbirth, anxiety), family/partner influence, and provider’s advice. Data analysis was performed using SPSS 26 with chi-square tests and multivariate logistic regression.
Results:
The acceptance of elective CS was 70%, with preference reported by 61%. Independent predictors included high tokophobia scores (AOR 1.04, p=0.010), exposure to negative vaginal birth stories (AOR 4.45, p=0.023), and provider type (AOR 0.11, p=0.032). Lower education and knowledge levels also correlated with increased acceptance.
Conclusion:
The findings highlight the importance of addressing psychological fears, misinformation, and provider influence through structured antenatal counseling, family engagement, and standardized communication. Strengthening health education and targeted interventions can reduce unnecessary elective CS and improve maternal outcomes.
Keywords: Elective cesarean section, Decision-making, Maternal factors, Patient preference, Obstetric outcomes