Influence of delivery characteristics and socioeconomic status on giving birth by caesarean section – a cross sectional study during 2000–2010 in Finland

Abstract

BackgroundCaesarean section (CS) rates especially without medical indication are rising worldwide. Most of indications for CS are relative and CS rates for various indications vary widely. There is an increasing tendency to perform CSs without medical indication on maternal request. Women with higher socioeconomic status (SES) are more likely to give birth by CS. We aimed to study whether giving birth by CS was associated with SES and other characteristics among singleton births during 2000–2010 in Finland with publicly funded health care.MethodsData were gathered from the Finnish Medical Birth Register. The likelihood of giving birth by CS according to CS type (planned and non-planned), parity (nulliparous vs. multiparous), socio-demographic factors, delivery characteristics and time periods (2000–2003, 2004–2007 and 2008–2010) was determined by using logistic regression analysis. SES was classified as upper white collar workers (highest SES), lower white collar workers, blue collar workers (lowest SES), others (all unclassifiable cases) and cases with missing information.ResultsIn total, 19.8% (51,511 of 259,736) of the nulliparous women and 13.1% (47,271 of 360,727) of the multiparous women gave birth by CS. CS was associated with several delivery characteristics, such as placental abruption, placenta previa, birth weight and fear of childbirth, among both parity groups. After adjustment, the likelihood of giving birth by planned CS was reduced by 40% in nulliparous and 55% in multiparous women from 2000–2003 to 2008–2010, whereas the likelihood of non-planned CSs did not change. Giving birth by planned and non-planned CS was up to 9% higher in nulliparous women and up to 17% higher in multiparous women in the lowest SES groups compared to the highest SES group.ConclusionsGiving birth by CS varied by clinical indications. Women with the lowest SES were more likely to give birth by CS, indicating that the known social disparity in pregnancy complications increases the need for operative deliveries in these women. Overall, the CS policy in Finland shows favoring a trial of labor over planned CS and reflects no inequity in healthcare services.

Cesarean section rates and local resources for perinatal care in Japan: A nationwide ecological study using the national database of health insurance claims

“…Our regression model could not detect any significant associations between the CS rates and low‐income households or women with a bachelor's degree (Table ). In contrast, a higher CS rate among women with lower socioeconomic status was reported, possibly reflecting a social gradient in pregnancy complications . One possible reason for this inconsistency is that the variables used in this ecological study were averaged over a geographic region.…”

“…In view of general relationships between socioeconomic factors and health, we included socioeconomic factors as possible related factors, and chose the percentage of women with a bachelor's degree and the percentage of low‐income households in each prefecture based on data availability. The percentage of women aged between 20 and 44 with a bachelor's degree was calculated using the 2010 Population Census.…”

A Three Year Retrospective Study of Caesarean Section Rate at Tanta University Hospitals

“…[12,13] On the other hand, several European countries have managed to control their CS rates over time by strict management of vaginal deliveries and strict policies on requesting CS plus legal framework for medical litigation. [14,15] Also the trend to apply vaginal birth after cesarean section decreased the rate of cesarean section. [16] The rate is unknown at Tanta University Hospitals so we conducted this study to determine the actual rate of CS at a tertiary care hospital.…”

Rising rates of caesarean section: an indicator of defensive medicine practiced by obstetricians

“…This is seen more often in women from higher socio-economic and education group. 29 It is seen that fear of long-term sequelae, specifically stress incontinence and anal sphincter damage, fear of perineal damage from vaginal delivery, concern about the long-term effect of vaginal delivery on sexual function, fear of damage to the baby and the desire of an electively timed delivery might have resulted in increasing rate of CS in primigravidae patients in prelabour. 30 …”