Factors associated with cesarean birth in nulliparous women: A multicenter prospective cohort study

Abstract

Background There is widespread concern around the rising rates of cesarean births (CBs), especially among first‐time mothers, despite evidence suggesting increased morbidities after birth by cesarean. There are uncertainties around factors associated with rising rates of CBs among first‐time mothers in Ireland, and insight into these is essential for understanding the rising trend in CBs. Therefore, this study aimed to identify the factors associated with CBs in nulliparous women. Methods A prospective cohort study was conducted in three maternity hospitals in the Republic of Ireland between 2012 and 2017. Data were collected from 3047 nulliparous women using self‐administered surveys antenatally and at 3 months postpartum and from consenting women’s hospital records (n = 2755) and analyzed using the Poisson regression to assess associations between demographic and clinical factors and the main outcome measures, planned and unplanned CBs. Results Common risk factors for planned and unplanned CBs were being aged ≥40 years, being in private care, multiple pregnancy, and fetus in breech or other malpresentations. An unplanned CB occurred for 22.43% (n = 377/1681) of women who did not have induction of labor (IOL) or who had IOL with no epidural, but the risk was about twice as high for women who had IOL and epidural. Conclusions Findings confirm multifactorial reasons for CB and the challenge of reversing the increasing CB rate if maternal age, overweight/obesity, infertility treatment, multiple pregnancy, and preexisting hypertension in Ireland continue to increase. There is a need to address prelabor interventions, especially IOL combined with epidural analgesia with respect to unplanned CB.

Optimizing caesarean section use and feasibility of implementing the Robson classification system: Perspectives of healthcare providers and policymakers

“…The continuing rise in CS rates is a public health concern due to higher maternal and perinatal risks, high costs, the need for healthcare efficiency, and inequality of access to services. 11 , 19 – 23 , 55 This study aimed to examine the viewpoints of healthcare providers and policymakers within the Israeli health system concerning the determinants influencing CS rates, as well as assess the preparedness and feasibility of implementing the RTGCS. This study was based on the assumption that involving healthcare professionals is essential to promoting systemic and effective processes.…”

“…These findings outline that Israel’s motives are similar to findings in other countries. Several studies mentioned motives such as the socio-demographic characteristics of the mother and/or a change in healthcare providers’ attitudes and perceptions toward the woman’s right to choose her delivery mode, 55 , 57 , 58 as major contributors to the increasing prevalence of CS. The extensive research literature has also shown an increase in CS by maternal request.…”

“…Notably, our study found that defensive medicine plays a role in increasing CS rates. According to Panda et al, 55 physicians’ “perceived fear” of legal implications due to clinicians’ past experiences, societal attitudes, and the media, influences decision-making and contributes to rising CS rates. Minkoff 62 stated that it is still unclear whether fear of litigation contributes to, or even drives, rising CS rates.…”

Predominant Maternal Risk Factors Increase the Prevalence of Caesarean Section Deliveries: A Cross-Sectional Study in a Reproductive-Aged Women Population

“…These contributing factors cannot be excluded in the overall analysis of delivery mode, since both pre-pregnancy BMI and gestational weight gain were related with higher rates of caesarean section, and they may act as confounding factors ameliorating the association of gestational diabetes with caesarean section [41]. Moreover, an increase in caesarean deliveries has been associated with elevated incidence for maternal pregnancy-induced hypertension [42,43]. However, in our study, we found only a marginal non-significant trend of correlation between caesarean section and gestational hypertension which may be ascribed to the low number of women developing gestational hypertension included in our study population.…”

Maternal and neonatal outcomes associated with multiple repeat cesarean deliveries: A registry-based study from Qatar

“…This advancement partially explains the rising trends, as CDs are increasingly performed even when medically not indicated. Factors such as advanced maternal age, maternal request, reluctance to accept an ill-perceived risk to the foetus in a vaginal delivery, increased rates of labor induction, declining rates of operative vaginal births, and improved access to health insurance contribute to the significant rise in primary CDs worldwide 4 .…”