Current Cesarean Section Rate and Factors Affecting the Patient Decision Regarding Mode of Delivery

Main Article Content

Robina Qadeer
Tehniyat Attiya ur Razaq
Humaira Khattak
Humaira Aman
Afrah Aman
Shamim Akthar

Abstract

Objectives: To determine the current cesarean section rate and factors leading to Cesarean Section on Maternal Request (CSMR). 


Methodology: This is a descriptive cross-sectional study, conducted at the Obstetrics & Gynecology Unit of Kuwait Teaching Hospital in Peshawar.  Data regarding cesarean section and factors affecting patient decisions regarding mode of delivery were collected through structured questionnaires from patients who provided informed consent. The study included patients admitted for a normal vaginal delivery but who requested to have optedhave an elective cesarean section, at.. Patients with obstetric indications for a C-section were excluded from the study. Data analysis was conducted using SPSS version 25 to determine percentages and frequencies.


 


Results: The C-section rate was found to be 36.7%, with 10% of these cases being performed as Cesarean Section at Maternal Request (CSMR). Among the women, 154 (40.84%) had previously had a C-section and to undergo another elective C-section instead of attempting a trial of labor. Additionally, 76 (20.15%) of women declined admission. In 50 (13.26%) of cases, C-sections were performed based on the gender of the newborn, with a preference for male babies. Thirty-six (9.54%) of women had no living children from prior pregnancies. Other reasons for CSMR were conceiving after more than 5 years (7.95%), previous bad experience with vaginal delivery (5.30%), and going for tubal ligation (2.91%). Besides the above-mentioned factors, 26% of women were influenced by the opinions of close relatives and friends. Thirty-seven (10%) of women were encouraged by their doctors, while 3% chose to have a “C-Section on Maternal Request (CSMR)" along with a bilateral tubal ligation to complete their families.


Conclusion: CSMR (Caesarean Section on Maternal Request) contributes significantly to the overall C-section rate. By addressing the factors influencing these decisions, the C-section rate could potentially be reduced.

Article Details

How to Cite
1.
Qadeer R, Tehniyat Attiya ur Razaq, Humaira Khattak, Humaira Aman, Afrah Aman, Shamim Akthar. Current Cesarean Section Rate and Factors Affecting the Patient Decision Regarding Mode of Delivery . J Postgrad Med Inst [Internet]. 2024 Dec. 31 [cited 2025 Jan. 8];38(4). Available from: https://jpmi.org.pk/index.php/jpmi/article/view/3489
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Original Article

References

Hamilton BE, Martin JA, Ventura SJ. Births: preliminary data for 2009. Natl Vital Stat Rep 2010;59(3):1-19.

Navaee M, Abedian Z. Effect of role play education on primiparous women's fear of natural delivery and their decision on the mode of delivery. Iran J Nurs Midwifery Res 2015;20(1):40-6.

Sharpe A, Waring G, Rees J, McGarry , Hinshaw K. Caesarean section at maternal request–the differing views of patients and healthcare professionals: a questionnaire based study. Eur J Obstet Gynecol Reprod Biol 2015;192:54-60.

Loke AY, Davies L, Li SF. Factors influencing the decision that women make on their mode of delivery: the Health Belief Model. BMC Health Serv Res 2015;15:1-12.

Alsayegh E, Bos H, Campbell K, Barrett J. No. 361-caesarean delivery on maternal request. J Obstet Gynaecol Can 2018;40(7):967-71.

Shaterian N, Alsadat Rahnemaei F, Ghavidel N, Abdi F. Elective cesarean section on maternal request without indication: reasons for it, and its advantages and disadvantages. Cent Eur J Nurs Midwifery 2021;12(3):458-69.

Monari F, Di Mario S, Facchinetti F, Basevi V. Obstetricians’ and midwives’ attitudes toward cesarean section. Birth 2008;35(2):129-35.

Aminu M, Utz B, Halim A, Van Den Broek N. Reasons for performing a caesarean section in public hospitals in rural Bangladesh. BMC Pregnancy Childbirth 2014;14:1-8.

Gao Y, Tang Y, Tong M, Du Y, Chen Q. Does attendance of a prenatal education course reduce rates of caesarean section on maternal request. A questionnaire study in a tertiary women hospital in Shanghai, China. BMJ Open 2019;9(6):e029437.

Zamani-Alavijeh F, Araban M, Hassanzadeh A, Makhouli K. Contributing factors of pregnant women’s beliefs towards mode of delivery: a cross-sectional study from Iran. Matern Health Neonatol Perinatol 2018;4:1-5.

Otkjaer AM, Jorgensen HL, Clausen TD, Krebs L. Maternal shortterm complications after planned cesarean delivery without medical indication: a registry-based study. Acta Obstet Gynecol Scand 2019;98(7):905-12.

Benli AR, Benli NC, Usta AT, Atakul T, Koroglu M. Effect of maternal age on pregnancy outcome and cesarean delivery rate. J Clin Med Res 2015;7(2):97-102.

Stoll KH, Hauck YL, Downe S, Payne D, Hall WA. Preference for cesarean section in young nulligravid women in eight OECD countries and implications for reproductive health education. Reprod Health 2017;14(1):116.

Begum T, Ellis C, Sarker M, Rostoker JF, Rahman A, Anwar I, et al. A qualitative study to explore the attitudes of women and obstetricians towards caesarean delivery in rural Bangladesh. BMC Pregnancy Childbirth 2018;18:1-11.

Einarsdottir K, Kemp A, Haggar FA, Moorin RE, Gunnell AS, Preen DB, et al. Increase in caesarean deliveries after the Australian private health insurance incentive policy reforms. PLoS One 2012;7(7):e41436.

Potter JE, Hopkins K, Faundes A, Perpetuo I. Women’s autonomy and scheduled cesarean sections in Brazil: a cautionary tale. Birth 2008;35(1):33-40.

Kanji Z, Simonovich SD, Najmi N, Bishop-Royse J. Examining clinical indications for cesarean section in a university hospital in Karachi, Pakistan. J Asian Midwives 2019;6(1):14-25.

Amjad A, Imran A, Shahram N, Zakar R, Usman A, Zakar MZ, et al. Trends of caesarean section deliveries in Pakistan: secondary data analysis from Demographic and Health Surveys, 1990–2018. BMC Pregnancy Childbirth 2020;20:753.

Jadoon I, Khattak M, Mughal KS, Mughal US, Khan M, Abdulsamad SA, et al. Rising cesarean section rates in Pakistan: analyzing frequency and key risk factors in a Tertiary-Care Hospital. Cureus 2024;16(10):e72333.

Azami-Aghdash S, Ghojazadeh M, Dehdilani N, Mohammadi M, Asl Amin Abad R. Prevalence and causes of cesarean section in Iran: systematic review and meta-analysis. Iran J Public Health 2014;43(5):545-55.