Rising Caesarean Section Rate – Whether Women Choice, Doctor Preference or Clinical /Non Clinical Indications are Responsible.
Background : To determine the factors responsible
for the rise in caesarean section rates whether
women choice, doctor preference or clinical /non
clinical indications are responsible.
Methods: In this observational study antenatal
patients of any age ,with any previous obstetric
history and parity were asked about their wishes
regarding mode of deliveries in the current
pregnancy irrespective of any clinical consideration.
Actual indications for caesarean done in the next 3
months were noted down and rate of caesarean and
frequencies for each caesarean indication were
calculated. Discussions with doctors regarding
reasons for caesarean decisions in their practices
were done and percentages were calculated for major
indications of caesarean in their practice.
Results:Among 558 antenatal women, majority
(74.1%) wished for vaginal delivery. Total caesarean
rate in 3 months was 42.8%. Previous one
caesareans(24.67%) or previous multiple
caesareans(21.83) were the commonest indications.
Clinicians revealed suspected fetal
compromise(intrapartum)(76.6%), previous one
caesareans(66.6%) and previous multiple
caesareans(50%) as the common indications. No
doctor agreed on economic incentive being the sole
reason for caesarean in their practice.
Conclusion: Majority of women wish to deliver
vaginally. The main reason for rise in caesarean rate
are clinical indications like previous one and
multiple caesareans , suspected fetal
compromise(intrapartum) and failure to progress.
Risk minimizing behaviour is prominent among non
clinical reasons for caesarean delivery.