{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T23:32:08Z","timestamp":1788219128403,"version":"build-2803163510"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T00:00:00Z","timestamp":1767657600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aimed to investigate, in an upper middle\u2013income country context, the impact of maternal psychological status and prenatal psychological education on the cesarean delivery on maternal request among primiparous women.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This prospective longitudinal study included 948 primiparous women who delivered at five hospitals between June 2023 and June 2024. Women with medical indications for cesarean section, multiparity, or incomplete data were excluded. Maternal anxiety and depression were assessed in the first, second, and third trimesters using the Self-Rating Anxiety Scale and Self-Rating Depression Scale. Childbirth fear was evaluated in the third trimester using the Wijma Delivery Expectancy\/Experience Questionnaire (W-DEQ). Multivariate logistic regression was used to examine factors associated with cesarean delivery on maternal request.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among the 948 participants, 543 (57.3%) had vaginal deliveries, while 405 (42.7%) underwent cesarean delivery on maternal request. Third-trimester anxiety, depression, and W-DEQ scores were significantly higher in the cesarean group (\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001 for all). Multivariate analysis revealed that conception via assisted reproductive technology (ART; OR = 2.12, 95% CI: 1.17\u20133.43), the presence of pregnancy-related illness (OR = 1.43, 95% CI: 1.09\u20132.08), and higher W-DEQ scores (OR = 1.08, 95% CI: 1.02\u20131.16) were independent risk factors for cesarean delivery on maternal request. Receipt of prenatal psychological education was associated with a 35% reduction in this risk (OR = 0.65, 95% CI: 0.38\u20130.91).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Maternal psychological distress and fear of childbirth are significant contributors to the decision for cesarean delivery on maternal request among primiparous women. In an upper middle\u2013income country context, prenatal psychological education may serve as an effective intervention to reduce childbirth fear and promote informed, evidence-based delivery decisions. Integrating routine mental health screening and targeted education into antenatal care could help curb the rising trend of unnecessary cesarean deliveries.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2025.1683360","type":"journal-article","created":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T06:35:32Z","timestamp":1767681332000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Psychological predictors of cesarean delivery on maternal request in upper middle-income settings and the mitigating role of prenatal psychological education: a multicenter longitudinal study"],"prefix":"10.3389","volume":"12","author":[{"given":"Tianjiao","family":"Liu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dongqiong","family":"Luo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanhong","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lu","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lan","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongyan","family":"Ma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Biao","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aijie","family":"Xie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,6]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"729","DOI":"10.1111\/aogs.15054","article-title":"Obesity and cesarean section rate among low-risk primiparous women in Victoria, Australia: a population-based study","volume":"104","author":"Mekonnen","year":"2025","journal-title":"Acta Obstet Gynecol Scand."},{"key":"B2","doi-asserted-by":"publisher","first-page":"408","DOI":"10.1186\/s12871-024-02736-x","article-title":"Knowledge, fear and acceptance rate of spinal anesthesia among pregnant women scheduled for cesarean section: a cross-sectional study from a tertiary care hospital in Karachi","volume":"24","author":"Shahid","year":"2024","journal-title":"BMC Anesthesiol."},{"key":"B3","doi-asserted-by":"publisher","first-page":"e70604","DOI":"10.1002\/hsr2.70604","article-title":"Prevalence and risk factors associated with cesarean section in Syria: a cross-sectional study of the two largest health centers","volume":"8","author":"Abdulrazzak","year":"2025","journal-title":"Health Sci Rep"},{"key":"B4","doi-asserted-by":"publisher","first-page":"e1002846","DOI":"10.1371\/journal.pmed.1002846","article-title":"Effect of a two-stage intervention package on the cesarean section rate in Guangzhou, China: a before-and-after study","volume":"16","author":"Xia","year":"2019","journal-title":"PLoS Med."},{"key":"B5","doi-asserted-by":"publisher","first-page":"138","DOI":"10.1111\/1471-0528.16951","article-title":"What is an appropriate cesarean delivery rate for China: a multicentre survey","volume":"129","author":"Zhang","year":"2022","journal-title":"BJOG."},{"key":"B6","doi-asserted-by":"publisher","first-page":"e0148343","DOI":"10.1371\/journal.pone.0148343","article-title":"The increasing trend in cesarean section rates: global, regional and national estimates: 1990-2014","volume":"11","author":"Betran","year":"2016","journal-title":"PLoS One."},{"key":"B7","doi-asserted-by":"publisher","first-page":"798","DOI":"10.1111\/1471-0528.16491","article-title":"Global incidence of cesarean deliveries on maternal request: a systematic review and meta-regression","volume":"128","author":"Begum","year":"2021","journal-title":"BJOG."},{"key":"B8","doi-asserted-by":"publisher","first-page":"1117","DOI":"10.1186\/s12913-023-10077-7","article-title":"Guideline documents on cesarean section on maternal request in Sweden: varying usability with a restrictive approach","volume":"23","author":"Mattebo","year":"2023","journal-title":"BMC Health Serv Res"},{"key":"B9","doi-asserted-by":"publisher","first-page":"286","DOI":"10.1186\/s12884-019-2440-2","article-title":"Is it the decision of women to choose a cesarean section as the mode of birth? A review of literature on the views of stakeholders","volume":"19","author":"Loke","year":"2019","journal-title":"BMC Preg Childbirth"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1093\/her\/cyae043","article-title":"The effect of motivational interview-based breastfeeding education on breastfeeding motivation, success, self-efficacy perceptions, and exclusive breastfeeding duration after cesarean section: a randomized controlled trial","author":"Bekmezci","year":"2025","journal-title":"Health Educ Res"},{"key":"B11","doi-asserted-by":"publisher","first-page":"219","DOI":"10.18502\/ijph.v53i1.14698","article-title":"A higher maternal education level could be a critical factor in the exceeded cesarean section delivery in Indonesia","volume":"53","author":"Yunitawati","year":"2024","journal-title":"Iran J Public Health"},{"key":"B12","doi-asserted-by":"publisher","first-page":"e79919","DOI":"10.7759\/cureus.79919","article-title":"Anxiety assessment using the visual analogue scale among women undergoing elective cesarean section","volume":"17","author":"Alexakis","year":"2025","journal-title":"Cureus"},{"key":"B13","doi-asserted-by":"publisher","first-page":"e70523","DOI":"10.1002\/hsr2.70523","article-title":"Can virtual reality technology reduce anxiety before a cesarean section in primigravida women?","volume":"8","author":"Mohammadi","year":"2025","journal-title":"Health Sci Rep"},{"key":"B14","doi-asserted-by":"publisher","first-page":"3867","DOI":"10.1080\/14767058.2019.1587407","article-title":"Reasons for elective cesarean section on maternal request: a systematic review","volume":"33","author":"Jenabi","year":"2020","journal-title":"J Matern Fetal Neonatal Med"},{"key":"B15","doi-asserted-by":"publisher","first-page":"1294","DOI":"10.1111\/1471-0528.15122","article-title":"Obstetrical providers' preferred mode of delivery and attitude towards non-medically indicated cesarean sections: a cross-sectional study","volume":"125","author":"Rivo","year":"2018","journal-title":"BJOG"},{"key":"B16","doi-asserted-by":"publisher","first-page":"807","DOI":"10.1080\/00016340902998436","article-title":"Women's fear of childbirth and preference for cesarean section\u2013a cross-sectional study at various stages of pregnancy in Sweden","volume":"88","author":"Nieminen","year":"2009","journal-title":"Acta Obstet Gynecol Scand"},{"key":"B17","doi-asserted-by":"publisher","first-page":"104207","DOI":"10.1016\/j.midw.2024.104207","article-title":"Psychometric evaluation of the wijma delivery expectancy\/experience questionnaire for pregnant women in Taiwan","volume":"140","author":"Lin-Lewry","year":"2025","journal-title":"Midwifery"},{"key":"B18","doi-asserted-by":"publisher","first-page":"2431","DOI":"10.3390\/healthcare12232431","article-title":"Prenatal maternal psychological stress (PMPS) and its effect on the maternal and neonatal outcome: a retrospective cohort study","volume":"12","author":"Aldinger","year":"2024","journal-title":"Healthcare (Basel)"},{"key":"B19","doi-asserted-by":"publisher","first-page":"249","DOI":"10.5455\/aim.2023.31.249-253","article-title":"Diagnostic value in screening severe depression of the hamilton depression rating scale, hamilton anxiety rating scale, Beck depression inventory scale, and Zung's self-rating anxiety scale among patients with recurrent depression disorder","volume":"31","author":"Tung","year":"2023","journal-title":"Acta Inform Med"},{"key":"B20","doi-asserted-by":"publisher","first-page":"931","DOI":"10.1186\/s12884-022-05283-w","article-title":"Validating the use of the Wijma delivery expectancy\/experience questionnaire in Mainland China: a descriptive, cross-sectional study","volume":"22","author":"Han","year":"2022","journal-title":"BMC Preg Childbirth."},{"key":"B21","doi-asserted-by":"publisher","first-page":"1448","DOI":"10.5498\/wjp.v14.i10.1448","article-title":"Analysis of risk factors for postpartum depression after cesarean section in women with early-onset preeclampsia","volume":"14","author":"Wang","year":"2024","journal-title":"World J Psychiatry"},{"key":"B22","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/07399332.2024.2385331","article-title":"Effects of music on perioperative anxiety in patients undergoing cesarean section - a randomised prospective controlled study","volume":"46","author":"Kirdemir","year":"2024","journal-title":"Health Care Women Int"},{"key":"B23","doi-asserted-by":"publisher","first-page":"593","DOI":"10.1080\/0167482X.2022.2126309","article-title":"The Chichewa Wijma delivery expectancy\/experience questionnaire: a factor analytic study for postpartum women in Malawi","volume":"43","author":"Khwepeya","year":"2022","journal-title":"J Psychosom Obstet Gynaecol"},{"key":"B24","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1016\/j.srhc.2012.06.003","article-title":"Indications for cesarean section on maternal request\u2013guidelines for counseling and treatment","volume":"3","author":"Wiklund","year":"2012","journal-title":"Sex Reprod Healthc"},{"key":"B25","doi-asserted-by":"publisher","first-page":"4527","DOI":"10.12998\/wjcc.v12.i21.4527","article-title":"Effect of psychological nursing intervention combined with acupressure on postoperative recovery of women after cesarean section","volume":"12","author":"Liu","year":"2024","journal-title":"World J Clin Cases"},{"key":"B26","doi-asserted-by":"publisher","first-page":"1930","DOI":"10.1001\/jama.2013.3982","article-title":"Elective cesarean delivery on maternal request","volume":"309","author":"Ecker","year":"2013","journal-title":"JAMA"},{"key":"B27","doi-asserted-by":"publisher","first-page":"2395","DOI":"10.4103\/0366-6999.216415","article-title":"Cesarean section rate in singleton primiparae and related factors in Beijing, China","volume":"130","author":"Song","year":"2017","journal-title":"Chin Med J (Engl)"},{"key":"B28","doi-asserted-by":"publisher","first-page":"100824","DOI":"10.1016\/j.ehb.2019.100824","article-title":"Differences in cesarean section rates by fetal sex among Chinese women in the United States: does Chinese culture play a role?","volume":"36","author":"Shen","year":"2020","journal-title":"Econ Hum Biol"},{"key":"B29","doi-asserted-by":"publisher","first-page":"e45","DOI":"10.1136\/medethics-2020-106071","article-title":"How to reach trustworthy decisions for cesarean sections on maternal request: a call for beneficial power","volume":"47","author":"Eide","year":"2020","journal-title":"J Med Ethics"},{"key":"B30","doi-asserted-by":"publisher","first-page":"150","DOI":"10.1016\/j.jad.2023.03.020","article-title":"Relationship between anxiety and depressive trajectories of women who conceived through assisted reproductive technology and their children's emotional and behavioral problems: a prospective cohort study","volume":"332","author":"Sun","year":"2023","journal-title":"J Affect Disord"},{"key":"B31","doi-asserted-by":"publisher","first-page":"1075","DOI":"10.18502\/ijrm.v19i12.10058","article-title":"Maternal-fetal attachment and anxiety in pregnant women who conceived through assisted reproductive technology: A longitudinal study","volume":"19","author":"Ranjbar","year":"2021","journal-title":"Int J Reprod Biomed"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1683360\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T06:35:35Z","timestamp":1767681335000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1683360\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,6]]},"references-count":31,"alternative-id":["10.3389\/fmed.2025.1683360"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2025.1683360","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,6]]},"article-number":"1683360"}}