ArticleBMJ open2026
Determinants of the choice of delivery mode in pregnant women: a convergent parallel mixed-methods study protocol.
Article in BMJ open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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5 authors.
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Abstract
backgroundThe mode of delivery is one of the most critical decisions in maternal care, influenced by psychological, social, cultural and medical factors. Despite the known benefits of vaginal delivery, the caesarean section rate (40%-55%) in Iran remains significantly higher than the WHO's recommended level (10%-15%). Fear of childbirth, anxiety, social norms and misinformation are among the key determinants shaping women's delivery preferences. Understanding these factors is essential for developing effective interventions to promote informed decision-making and reduce unnecessary caesarean sections. Thus, the study aims to assess the determinants of the choice of delivery mode in pregnant women. METHODS AND ANALYSIS: This study will employ a convergent parallel mixed-methods design to comprehensively investigate the determinants of delivery mode choice among pregnant women. In the quantitative phase, a cross-sectional study will be conducted among 768 primigravid women attending health centres in Tabriz, Iran. Data will be collected using standardised instruments such as the Childbirth Fear Questionnaire, Depression, Anxiety and Stress Scale (DASS-21) and researcher-developed questionnaires addressing sociocultural, environmental and educational factors. Statistical analyses will include descriptive and inferential tests such as χ ETHICS AND DISSEMINATION: This study has received ethical approval from the Ethics Committee of Tabriz University of Medical Sciences, Tabriz, Iran (IR.TBZMED.REC.). Study findings will be disseminated through peer-reviewed journals and scientific conferences. The study started in August 2025 and will continue until 2027. A similar study design will be implemented in a national, multicentre setting during this period.
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