Development of research ethics guidelines for healthcare generative artificial intelligence: deriving expert consensus through a Delphi study.

Caesarean section (CS) is a life-saving surgical procedure when medically indicated; however, its use has increased markedly across many regions of the world, raising concern about potential overuse in low-risk pregnancies ([, ]). Large national and population-based studies demonstrate substantial variation in CS rates across and within countries, variation that cannot be explained by obstetric risk alone and points to the influence of non-clinical factors [, , ]. Decisions regarding mode of delivery are shaped by a complex interaction of medical advice, personal experience, perceptions of safety and pain, and the organisation of maternity care [, ]. Women’s beliefs about childbirth, particularly fears related to labour pain, bodily harm, recovery, and neonatal safety, have consistently been shown to influence preference for CS, even in the absence of clear medical indications [–]. Several studies indicate that many women perceive CS as safer or more predictable for the baby, while simultaneously recognising that it is associated with longer maternal recovery and extended hospital stay []. In an Indian hospital-based study, preference for caesarean delivery was primarily driven by perceived foetal safety, whereas preference for vaginal delivery (VD) was commonly linked to expectations of faster maternal recovery []. Prior childbirth experience plays a central role in shaping subsequent delivery preferences. Evidence from diverse settings consistently shows that women with a previous CS are substantially more likely to prefer repeat caesarean delivery, whereas women with prior vaginal birth tend to express greater confidence in VD and a lower preference for CS ([, , ]).