Associations Between Antenatal Care and Information and Pregnant Women’s Preferred Mode of Birth in Romania: A Cross-Sectional Study

Objectives: Romania has one of the highest caesarean rates in the European Union, yet little is known about what shapes women’s preferred mode of birth there. This study examined how socio-demographic, obstetric and antenatal care characteristics relate to preferred mode of birth, with a focus on modifiable factors such as the information received during pregnancy, attendance of antenatal classes and access to midwifery care. Methods: A cross-sectional questionnaire study of 1301 pregnant women recruited online was conducted in Romania between January and July 2023. The association between each characteristic and preferred mode of birth was tested with Pearson’s chi-square test, and effect size was quantified with Cramér’s V. p-Values were adjusted for multiple comparisons with the Bonferroni method, and factors independently associated with preference were identified with multinomial logistic regression (reference category: vaginal birth). Results: One-third of the women preferred caesarean birth (33.4%), just under one-third preferred vaginal birth (29.9%), and 36.7% were undecided. Among parous women, preference was associated with the mode of a previous birth (V = 0.42); in the whole sample, the largest effect size was for the information the physician gave about the birth process (V = 0.36), followed by information about breastfeeding (V = 0.24), the number of antenatal consultations (V = 0.22) and information about early skin-to-skin contact (V = 0.21). Socio-demographic factors showed weaker associations. After Bonferroni adjustment, place of residence and perceived usefulness of access to a midwife were no longer significant. In the multivariable model (n = 1301), a previous caesarean (aOR 5.06), thorough physician information about birth (aOR 2.77) and age of 30 years or over were independently associated with preferring caesarean, whereas antenatal class attendance (aOR 0.35) and thorough information about breastfeeding (aOR 0.40) were associated with lower odds of preferring caesarean. Indecision clustered among women who had received little information and had fewer consultations. Conclusions: In this predominantly urban and highly educated online sample, preferred mode of birth was associated with previous mode of birth, with potentially modifiable antenatal care and information exposure and with some socio-demographic characteristics. Given the cross-sectional design, these associations are not causal, and whether midwife-led antenatal education and counselling support informed choice should be tested in longitudinal or interventional studies.