Study On Influencing Factors Of Cesarean Section Without Indication From The Perspective Of Medicalization Theory

Objective: Under the background of medicalization theory and the social background of high cesarean section rate in China,through qualitative research methods,from the perspective of parturients,this study is to research the factors affecting the choice of cesarean section by unindicated parturients,so as to further reduce cesarean section rate in China,especially to reduce the proportion of non-indication cesarean section,and to promote the moderate promotion of maternal medicalization and the better development of maternal and child health in China.Methods: First,on the basis of consulting the current literature on the medicalization of pregnancy and labor and non-indicative cesarean section,a semi-structured interview outline was drawn up,pre-investigation was conducted to adjust the outline.Then the grounded theory was used,and the theoretical sampling was taken as the guiding principle with purpose sampling and snowball sampling as specific operating methods.Parturients who met the requirements of the study to conduct in-depth interviews were included.In this process,with the help of qualitative research software Nvivo12.0,the interview data were analyzed by three-level coding of open coding,spindle coding and selective coding.Data collection and analysis were carried out alternately until the theoretical saturation was reached,and a total of 21 parturients were finally included.Finally,combined with the original data,the coding results were fully discussed under the medicalization theory.Results: Through three-level coding,182 free nodes(conceptualization),60 tree nodes(open coding),10 core categories(principal axis coding)and 3 core categories(selective coding)were extracted.Through the comparative analysis of the genera and the original data,a clear story line is formed: the choice of cesarean section without indication was affected by many factors,including personal factors,social and cultural factors and medical factors.Among them,personal factors were the main reasons,including physical factors,pain factors,psychological factors,knowledge factors,while social and cultural factors and medical factors might directly or indirectly affect the final decision-making of parturients.Conclusion: The factors contributing to the medicalization phenomenon of nonindicative cesarean section are as follows:(1)Parturients will actively collect the information they need through various channels,but because of the large amount of information and the mixed content of good and bad information,they gradually produce and identify with a lot of wrong cognition and ideas in this process,which plays a negative role in their follow-up decision-making process;(2)Pain is an important reason for many parturients to choose cesarean section,but the idea and concept of fear of pain and dependence on cesarean section are not inherent in parturients,but gradually produced and solidified in their life and social activities;(3)Parturients who are older,have a history of cesarean section,are accompanied by non-absolute indications and are potentially influenced by the idea of "inheriting the family line" in traditional culture,out of the psychology of "reducing risk" and "for the sake of safety",resulting their choices of cesarean section to ensure the safety of mother and baby;(4)When the complaint is not satisfied,some parturients will seek the help of acquaintance physicians.(5)The requirements of maternal family members for "zero-risk delivery",insufficient hospital education,the relaxation of physicians’ indications for cesarean section,the low popularization rate of painless delivery and the uncertainty of delivery environment are all factors that indirectly lead to the choice of cesarean section.To sum up,parturients play an active role in the phenomenon of non-indicative cesarean section,rather than passive recipients.Parturients,their families,physicians,cultural background and other micro factors work together with social environment,medical environment and other macro factors to speed up the process of medicalization of pregnancy and childbirth.This suggests that the state,government and medical institutions should intervene in this by increasing the popularization rate of painless delivery,strengthening health education during pregnancy,strengthening standardized management of obstetrics,optimizing the delivery environment and other measures to further put an end to the occurrence of unindicated cesarean section and reduce the negative impact of medicalization of pregnancy and delivery.