Epidemiology of Caesarean section on maternal request in Australia: A population-based study. (February 2023)

• Record Type: Journal Article
• Authors: Begum, Tahmina; Anuradha, Satyamurthy; Fatima, Yaqoot; Mamun, Abdullah Al
• Is Part Of: Midwifery. Volume 117(2023)
• Publication Date: 2023-02
• Subjects: C-section on maternal request -- Determinants of CSMR -- Risk of CSMR -- Maternal morbidities -- Neonatal complications -- Australia; Midwifery -- Periodicals; Midwifery -- Periodicals; Sages-femmes -- Périodiques; Midwifery; Periodicals; Electronic journals; 618.2005
• DOI: 10.1016/j.midw.2022.103578
• Languages: English
• ISSNs: 0266-6138

Abstract

Abstract: Objective: To explore the trends, determinants, and short-term maternal and neonatal health outcomes of Caesarean section on maternal request (CSMR). Design: Population-based record linkage study. Setting: Birth registry data for all births in Queensland, Australia, from 2008 to 2017. Participants: Pregnancies resulting in live or intrapartum stillbirth with >=20 gestational weeks and/or >=400 gm birth weight were the study population. The analytic sample was restricted to low-risk pregnancies by excluding preterm, non-cephalic pregnancies with medical risk factors. Measurements: CSMR was defined as a first-time C-section in singleton, term pregnancies with an ICD-10-AM code of O-82/O-47. CSMR trend was reported in age-standardised rate using a join-point regression model. The determinants and perinatal outcomes of CSMR were tested against Spontaneous vaginal births (VBs) and planned VBs including assisted VBs and emergency C-sections in this group. The generalised estimating equation technique was used for regression analysis and reported in the odds ratio (OR) at a 95% Confidence Interval (CI). Findings: Of total C-sections ( n = 204, 863), the average annual change in CSMR rate was 4.4% (95% CI: 2.1–6.7%, p <0.01) for the total pregnancies (N=613, 375) Of the analytic sample (N=365568 ), nulliparous women with age ≥35 years (OR: 2.32, 95% CI: 2.09–2.57), delivered at private hospitals (OR:4.90; 95% CI: 4.65–5.18); with mood disorders (OR: 2.15; 95% CI: 1.88–2.43) were positive and midwives birth attendant (OR 0.28; 95% CI: 0.26 to 0.30) was negative influencing factors for CSMR. In a propensity score matched sample; CSMR observed an increasedrisk of anaesthetic complications (OR: 8.00; 95% CI:1.95–32.82) and slightly reduced odds of birth asphyxia (OR:0.20;95%CI:0.06–0.60)against planned VBs while the overall incidence of birth-asphyxia was low (1.29%) However, neonatal morbidities (OR:1.61; 95% CI:1–2.59) and special care admission (OR:2.15; 95% CI:1.03–4.5) were higher after CSMR in comparison to SVBs Conclusion: Despite being linked with adverse perinatal health outcomes, the incidence of CSMR increased 1.75-fold during the past 10 years. Maternal educational interventions to provide adequate information, including the long-term risks and benefits of C-sections, can help reduce the growing rates of CSMR.