Indications and determinants of caesarean section delivery: Evidence from a population-based study in Matlab, Bangladesh

Abstract

Background and methodsCaesarean section (C-section) is a major obstetric intervention for saving lives of women and their newborns from pregnancy and childbirth related complications. Un-necessary C-sections may have adverse impact upon maternal and neonatal outcomes. In Bangladesh there is paucity of data on clinical indication of C-section at population level. We conducted a retrospective study in icddr,b Health and Demographic Surveillance System (HDSS) area of Matlab to look into the indications and determinants of C-sections. All resident women in HDSS service area who gave birth in 2013 with a known birth outcome, were included in the study. Women who underwent C-section were identified from birth and pregnancy files of HDSS and their indication for C-section were collected reviewing health facility records where the procedure took place, supplemented by face-to-face interview of mothers where data were missing. Indications of C-section were presented as frequency distribution and further divided into different groups following 3 distinct classification systems. Socio-demographic predictors were explored following statistical method of binary logistic regression.FindingsDuring 2013, facility delivery rate was 84% and population based C-section rate was 35% of all deliveries in icddr,b service area. Of all C-sections, only 1.4% was conducted for Absolute Maternal Indications (AMIs). Major indications of C-sections included: repeat C-section (24%), foetal distress (21%), prolonged labour (16%), oligohydramnios (14%) and post-maturity (13%). More than 80% C-sections were performed in for-profit private facilities. Probability of C-section delivery increased with improved socio-economic status, higher education, lower birth order, higher age, and with more number of Antenatal Care use and presence of bad obstetric history. Eight maternal deaths occurred, of which five were delivered by C-section.ConclusionsC-section rate in this area was much higher than national average as well as global recommendations. Very few of C-sections were undertaken for AMIs. Routine monitoring of clinical indication of C-section in public and private facilities is needed to ensure rational use of the procedure.

Not just numbers: beyond counting caesarean deliveries to understanding their determinants in Ghana using a population based cross-sectional study

“…This present study found that 18.5% of women who delivered in health facilities 5 years preceding the survey delivered their babies through CS, a figure that exceeds the threshold of 5-15% recommended by WHO [7]. This corroborates the findings in previous studies in low-and -middle income countries such as Pakistan [1], Egypt, [11], Bangladesh [12], Ethiopia [31], India [32], Jordan [33] and Tanzania [34]. An improved propensity toward available medical interventions and continued discouragement of VD after previous CS may have added to the recent increase in CS rates as noted in other countries [35].…”

“…Those aged 45-49 had higher odds of CD compared to those aged [15][16][17][18][19]. Findings of the current study, which involved data from a wider coverage of women across Ghana show evidence that advanced maternal age is a higher risk factor for CS and that the extent of the risk surges with advancement in maternal age, a finding that is corroborated in other studies [1,11,12,28,29,[37][38][39]. Berkowitz et al [40] reiterated that advanced maternal age is generally believed to be associated with increased risk for adverse pregnancy outcome.…”

“…Fourteen independent variables were selected but not chosen arbitrary. The selection was guided by the varied conclusions drawn from some previous studies [1,11,12,14,28,29] to be having an association with CD. The independent variables that were used in this study were; maternal age, marital status, education, occupation, wealth status, residence, region, religion, ethnicity, parity (Birth order), number of ANC visits, sex of the baby, size of the baby, and household head's sex.…”

“…In countries with high prevalence of CD, the factors that contribute to the high rates are low priority of enhancing women's own abilities to give birth, side effects of common labour interventions, refusal to offer the informed choice of vaginal birth, casual attitudes about surgery and variation in professional practice style, limited awareness of harm more likely with CD, and incentives to practice in a manner that is efficient for providers [1,4]. Other factors such as type of health facility-public or private [1], age [1,11,12], birth order [13][14][15], birth weight [11], place of residence [1,16], region of residence [1], socioeconomic status, maternal educational level [1,17], maternal request [18] and wealth status [1,17] have all been found to be associated with CS. Most low-and -middle-income countriess (LMICS), however, report CD rates well below the acceptable minimum standard of 5% outlined by the WHO.…”

Maternal Health Care in Cox’s Bazar, Bangladesh: A Survey of Midwifery Experience at Hope Foundation and a Review of the Literature

“…Selected studies suggest that the overall cesarean section rate is higher than global recommendations. A retrospective survey of an area of Dhaka, Bangladesh identified a 35% cesarean delivery rate with only 1.4% conducted due to absolute maternal indications [32]. According to data produced by Save the Children (2019) the cesarean section rate in private facilities is approximately 80% and has increased by 51% over the past two years [33].…”