Non-medical reasons affecting cesarean section rate in teaching hospitals in Anbar province, Iraq

Abstract

Background: Globally, there is an increment in the cesarean section rate. Although the cesarean section is a lifesaving surgery in some cases, it is not safer than vaginal delivery and associated with higher maternal and perinatal complications. Many cesarean sections nowadays are performed for non-medical reasons, and decision-making is affected by social factors and the health standards of the community. Objectives: The objective of this study is to assess the non-medical reasons for cesarean sections. Method: This cross-sectional descriptive study was conducted in two teaching hospitals in Anbar province/Iraq. Women who underwent planned cesarean section at term were included. The inclusion criteria were cephalic fetal presentation, normally sited placenta, and no previous uterine scar. A questionnaire was set regarding the medical causes of planned cesarean section and any non-medical reasons that affect the decision-making. Seniors in obstetrics and gynecology in these hospitals responsible for these women were asked to fill in these questionnaires. Results: Out of 82 women included in the study, 11% were aged 35 years or more and 65.9% were nullipara. About 43.9% of the cesarean sections were performed for a purely medical cause and 34.1% had a medical cause for terminating the pregnancy. Still, decision-making was affected by non-medical reasons, and in 22% of the cases, cesarean sections were done without medical causes. A maternal request for cesarean section was the most common reason for those who underwent cesarean section without a medical cause. Conclusion: Proper maternal counseling about the potential risks of cesarean section and improving health care in the labor room can help in decreasing the cesarean section rate and its associated mortality and morbidity.