• I Faisal, N Matinnia, A R Hejar, and Z Khodakarami.
• Department of Community Health, Faculty of Medicine and Health Sciences, University Putra Malaysia, Serdang, Selangor, Malaysia.
• Midwifery. 2014 Feb 1; 30 (2): 227-33.

Objectiveto gain a deeper understanding of why Iranian primigravidae request caesarean section without any medical indication.Designqualitative study. Data were gathered through semi-structured interviews, and thematic analysis was undertaken.Settingfour health care centres at Hamadan University of Medical Sciences, Hamadan, Iran.Participants14 primigravidae who requested caesarean section without any medical indication.Findingsreasons for requesting caesarean section were related to fear of childbirth (labour pain, injury to mother or infant), complications after vaginal delivery (vaginal prolapse, urinary incontinence, sexual dysfunction), trust in obstetricians, and lack of trust in maternity ward staff.Key Conclusions And Implications For Practicethe main reasons given for requesting caesarean section show that there is urgent need for effective antenatal assessment to enable pregnant women to ask questions and express their concerns. In order to promote vaginal birth, there is a need to develop antenatal education and strategies to enhance women's knowledge, confidence and competence about vaginal birth. Health care providers should be re-educated about the observance of medical ethics and professional rules in their practices, and change their attitudes and behaviours to vaginal birth. Evaluation, improvement and change in maternity care policies are recommended to promote natural childbirth.Copyright © 2013 Elsevier Ltd. All rights reserved.

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