Prevalence and predictors of elective and emergency caesarean delivery among reproductive-aged women in Bangladesh: evidence from demographic and health survey, 2017–18

Abstract

Background Over the years, an increasing trend of unnecessary caesarean section (c-section) deliveries has raised concerns in Bangladesh. So far, many studies have reported the risk factors of c-section delivery in Bangladesh. However, most of these studies did not estimate the predictors of the two c-section procedures (i.e., emergency and elective) separately based on the timing of the c-section decision. This study solely brings forward the role of socio-demographic and economic factors that may be associated differently with emergency and elective c-section deliveries. Methods Data for the study were drawn from the 2017–18 Bangladesh Demographic and Health Survey with 5,299 women aged 15–49 years who gave birth at a health facility during three years preceding the survey. Descriptive statistics along with bivariate analysis were used to fulfill the study objectives. Further, multivariable logistic regression analysis was conducted on binary outcome variables of elective/emergency c-section deliveries. Results Approximately one-third of women in the reproductive-age group opted for delivery through c-section. Out of them, 18.7% of women had elective c-sections, and 14.1% had emergency c-sections. Women who had mass media exposure were 32% more likely to deliver through elective c-sections than women who had no exposure [AOR: 1.32; CI: 1.02–1.72]. Women with higher education had a 56% lower likelihood of delivering through emergency c-section than women with no educational status [AOR: 0.44; CI: 0.24–0.83]. Children from the third or higher birth order were significantly more likely to be delivered through elective c-sections than those from the first birth order [AOR: 2.67; CI: 1.75–4.05]. In contrast, children with higher birth order had fewer chances of emergency c-section than children with first birth order [AOR: 0.29; CI: 0.18 -0.45]. Both elective and emergency c-section deliveries were significantly higher among private health facilities. Conclusion Although c-section delivery has emerged as a life-saving intervention, the overuse of such practice has created lucrative risks for the mother and unborn child. Proper sensitization of mothers and families can enhance the knowledge of the unsafe nature of unnecessary c-section deliveries. Authorizations in case of over-use of elective and emergency c-sections should be observed to minimize the unnecessary c-sections and related complications and to increase normal institutional deliveries in Bangladesh.

From Necessity to Preference: A Study of Predictors Influencing Elective Caesarean Section in Rwanda

“…The study findings showed that mothers who were 30 years and above were more than twice likely to choose elective CS. This study findings correspond with similar studies conducted (13,41,43,45). Older mothers may choose elective CS because of their previous experience with childbirth, particularly through vaginal delivery.…”

“…To have valid and reliable predictors of elective CS, compared to other similar studies (41,43,45), this study used backward stepwise regression to select most influential predictors of elective CS in Rwanda. By eliminating the unnecessary predictors of elective CS in this current study, the model is easier to understand and interpret, particularly as the study findings could influence decision-making.…”

Determinants of cesarean mode of childbirth among Rwandan women of childbearing age: Evidence from the 2019–2020 Rwanda Demographic and Health Survey (RDHS)

“…This suggests that a high level of education improves access to healthcare services, where good pregnancy surveillance prevents complications that lead to CD, in particular emergencies. According to the present study findings, women from wealthy families were more likely to have CD than those from low-income families, and this is consistent with previous research [10,12,15,37]. Various studies have suggested that financial constraints in the developing world contribute to the unavailability of many healthcare interventions, including CD [38].…”

Caesarean Section on Maternal Request

“…Women who opt for CSMR should be delivered no earlier than 39 weeks of gestation unless there are other clinical indications. It is crucial for women to be well informed about the risks of placenta praevia, placenta accreta spectrum, intrauterine mortality and caesarean hysterectomy in subsequent pregnancies [4]. Therefore, it is essential to provide these women with adequate knowledge before they can make significant decisions and exercise their autonomy competently as patients.…”

“…A planned or elective caesarean section is performed before the onset of labour. Contrarily, an emergency C-section is a procedure performed before or during labour out of concern for the mother or the foetus [4].…”