Pregnancy and childbirth are considered as important events in the life of a woman. However, in some cases, the childbirth process might turn into a stressful experience for a woman if it involves medical complications resulting into caesarean section surgery [1]. Along with medical reasons, the belief system, behavioural patterns, and lack of awareness among women also affect their decision regarding the mode of childbirth [2]. Several studies reveal that psychological, social and cultural factors tend to influence the perceptions of women about pregnancy and childbirth process [2, 3]. Caesarean sections have become more of a social issue since a significant number of pregnant women have started to choose caesarean sections even without medical indications, resulting in its upsurge worldwide [4]. This increase has attracted the attention of experts in the field of public health globally. Likewise, assessing the gravity of this issue, the World Health Organization recommends that the caesarean section rate should not exceed 15% in any country across the globe [5].
Caesarean section rate has been varying in different parts of the world. In many countries, the rate of caesarean sections has reached 25% [6]. Likewise, most recent data indicate that the current rate of caesarean sections is 19.6% in Pakistan. For that reason, Pakistan is amongst those developing countries that are responsible for the worldwide increase in caesarean sections [7]. Despite certain side effects and post-delivery complications, caesarean sections are emerging as the first choice for childbearing worldwide [6].
There can be several factors behind the upsurge of caesarean sections including the greater involvement of medical technology to overcome childbirth complications [8]. It has been observed that the medicalisation of childbirth has also increased the concerns regarding the malpractices associated with the use of medical technology by the doctors, who may prefer an unnecessary caesarean surgery for their convenience, quick handling to save time or economic incentives [9]. Additionally, the inadequate knowledge of pregnant women about delivery complications tends to increase the likelihood of their exploitation for economic gain by the medical staff [10]. In such cases, it becomes easy for physicians and hospital authorities to persuade women and their families to opt for caesarean sections by associating the method with the security of mother and child health, even when the baby could be delivered normally [9, 10].
The research studies conducted with an aim to understand the preference of caesarean sections over vaginal birth highlight multiple factors including request by pregnant woman, women’s age at the time of childbirth, expectancy of twins or multiple foetus, induced labour, breach presentation of baby, and previous history of caesarean section [11, 12]. Additionally, fear of labour pain, physical impact of vaginal delivery, convenience of delivery in an estimated and certain time, and decreased risks related to neonatal and pelvic floor are considered as other significant reasons for the preference of caesarean sections over vaginal births [13]. In most of the countries, women are given a choice to opt either for vaginal or caesarean delivery. Thus, in order to elect the mode of delivery, women experience a subjective decision-making process influenced by several factors [14]. Culture, societal perceptions, personal insights, and awareness collectively influence the decision-making process and preferences of women in a society [15]. Similarly, the role of culture has a significant impact on women’s perceptions toward pregnancy, childbirth process, and preference of delivery mode [16].
Despite this backdrop, there is a paucity of research about pregnant women’s preferential patterns related to caesarean sections. There is scarcity of research studies in Pakistan to examine the perceptions of women and gynaecologists regarding social and cultural factors contributing to the upsurge of caesarean sections. Therefore, the present study aims to examine social and cultural aspects highlighted by women who are either currently pregnant or delivered via caesarean section and gynaecologists that influence the preference of caesarean section over vaginal childbirth in the Pakistani context.