Incidence and Determinants of Caesarean Section in Shiraz, Iran.

Mahnaz Zarshenas,Yun Zhao,Colin W Binns,Jane A Scott

doi:10.3390/ijerph17165632

Abstract

The rate of Caesarean section (CS) without medical indication has increased markedly worldwide in the past decades. This study reports the incidence of CS and identifies the determinants of elective and emergency CS as separate pregnancy outcomes in a cohort of Iranian women. Mothers (n = 700) of healthy, full-term infants were recruited from five maternity hospitals in Shiraz. The association between maternal socio-demographic and biomedical factors with mode of delivery was explored using multivariable, multinomial logistic regression. Most mothers underwent either an elective (35.4%) or emergency (34.7%) CS. After adjustment, women were more likely to deliver by elective CS than vaginally if they were older (≥30 year) compared to younger mothers (<25 year) (Relative Risk Ratio (RRR) 2.22; 95% Confidence Interval (CI) 1.28, 3.84), and had given birth at a private hospital (RRR 3.64; 95% CI 1.79, 7.38). Compared to those educated to primary or lower secondary level, university educated women were more likely to have undergone an elective (RRR 2.65; 95% CI 1.54, 4.58) or an emergency CS (RRR 3.92; 95% CI 2.27, 6.78) than a vaginal delivery. Similarly, overweight or obese women were more likely than healthy weight women to have undergone an elective (RRR 1.91; 95% CI 1.27, 2.87) or an emergency CS (RRR 2.02; 95% CI 1.35, 3.02) than a vaginal delivery. Specialist education of obstetricians and midwives along with financial incentives paid to private hospitals to encourage natural delivery may help in the reduction of unnecessary CS in Iran. In addition, to increase their childbirth knowledge and self-efficacy, pregnant women need to have the opportunity to attend purposefully designed antenatal childbirth preparation classes where they receive evidence-based information on natural childbirth and alternative methods of pain control, as well as the risks and indications for CS.

Highlights

When used appropriately, Caesarean section (CS) is an important intervention in reducing maternal and perinatal mortality and morbidity
The high rates of CS in Iran and other countries suggest that many women undergo a CS for reasons that are not justified on medical grounds
This study reports the incidence of CS and identifies the socio-demographic and biomedical factors associated with delivery by CS of a cohort of healthy, full-term Iranian infants

Summary

Introduction

Caesarean section (CS) is an important intervention in reducing maternal and perinatal mortality and morbidity. A recent systematic review [1] reported that at the population level CS rates higher than 10% are not associated with reductions in maternal and newborn mortality rates. It is unclear, what the optimal rate of CS should be to minimise maternal and infant morbidity outcomes associated with complicated pregnancies [1]. Iran has one of the highest rates of CS in the world, and in 2009, at 47.9%, it was higher than other countries in the Eastern Mediterranean region [2]. The high rates of CS in Iran and other countries suggest that many women undergo a CS for reasons that are not justified on medical grounds. A large proportion of CS in Iran, in private hospitals, are elective CS and performed due to the preferences of the health care provider

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Discussion

Conclusion