Exploring Labor Analgesia as an Alternative to Caesarean Section: A Cross-Sectional Study on What Influences Painless Delivery Intentions Amongst Pregnant Women

Abstract

Background: In early 2025, the report by the World Health Organization indicates that caesarean section use continues to rise accounting for more than 21% of all world childbirths and predicts that C-sections will be used in nearly 30% of all births globally by 2030, this being well above intended rate of roughly 10%-15%. The rate of caesarean section in Brazil is over 50%, and in China, it is already as high as 41%, of which 31.2% are undertaken without clinical indication. Labor analgesia can reduce the rate of caesarean section by influencing women's willingness to give birth vaginally. Yet, many pregnant women are not aware of the painless delivery alternatives. Objective: The objective of this article is to generate evidence on painless delivery intentions among pregnant women and identify influencing factors. Methodology: A total of 404 pregnant women were surveyed using the general information questionnaire and the self-rating scale of painless intention to deliver based on the theory of planned behavior. STROBE protocol guidelines were followed. Results: Pearson correlation analysis was performed based on the scores of basic knowledge, behavioral attitude, subjective norm, and perceptual behavior control of the self-rating scale of painless delivery intention in the planned behavior theory. The results suggest a positive correlation between basic knowledge, behavioral attitude, subjective norm, and perceptual behavior control, with correlation coefficients. Rural versus urban backgrounds and monthly household income were the two main influencing factors for the choice of painless delivery. Further correlation analysis revealed that perceived behavioral control exhibited the strongest correlation with behavioral intention in the linear regression model for total intention score, which was the largest in magnitude among all predictors, indicating it is the strongest predictor of behavioral intention toward painless childbirth. Conclusions: The results of this study suggest that there are a number of health management challenges for healthcare professionals, in general and nursing professionals, in particular. A key challenge is the ongoing need to generate international evidence on the current status of painless delivery intentions among pregnant women and identify influencing factors. This type of evidence will allow a diverse set of comparative international options for intervention based on the different influencing factors identified in this study.