Fatemeh College of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz 71348-14336, Iran.
School of Public Health, Curtin University, Perth 6102, Australia.
Int J Environ Res Public Health. 2020 Aug 5;17(16):5632. doi: 10.3390/ijerph17165632.
The rate of Caesarean section (CS) without medical indication has increased markedly worldwide in the past decades. This study reports the incidence of CS and identifies the determinants of elective and emergency CS as separate pregnancy outcomes in a cohort of Iranian women. Mothers ( = 700) of healthy, full-term infants were recruited from five maternity hospitals in Shiraz. The association between maternal socio-demographic and biomedical factors with mode of delivery was explored using multivariable, multinomial logistic regression. Most mothers underwent either an elective (35.4%) or emergency (34.7%) CS. After adjustment, women were more likely to deliver by elective CS than vaginally if they were older (≥30 year) compared to younger mothers (<25 year) (Relative Risk Ratio (RRR) 2.22; 95% Confidence Interval (CI) 1.28, 3.84), and had given birth at a private hospital (RRR 3.64; 95% CI 1.79, 7.38). Compared to those educated to primary or lower secondary level, university educated women were more likely to have undergone an elective (RRR 2.65; 95% CI 1.54, 4.58) or an emergency CS (RRR 3.92; 95% CI 2.27, 6.78) than a vaginal delivery. Similarly, overweight or obese women were more likely than healthy weight women to have undergone an elective (RRR 1.91; 95% CI 1.27, 2.87) or an emergency CS (RRR 2.02; 95% CI 1.35, 3.02) than a vaginal delivery. Specialist education of obstetricians and midwives along with financial incentives paid to private hospitals to encourage natural delivery may help in the reduction of unnecessary CS in Iran. In addition, to increase their childbirth knowledge and self-efficacy, pregnant women need to have the opportunity to attend purposefully designed antenatal childbirth preparation classes where they receive evidence-based information on natural childbirth and alternative methods of pain control, as well as the risks and indications for CS.
在过去几十年中，全球范围内无医学指征的剖宫产率显著增加。本研究报告了剖宫产率，并确定了选择性和紧急剖宫产的决定因素，将其作为伊朗女性队列中的两种单独的妊娠结局。从设拉子的五家妇产医院招募了健康足月婴儿的母亲（=700 人）。使用多变量多项逻辑回归探讨了母亲的社会人口统计学和生物医学因素与分娩方式之间的关联。大多数母亲接受了选择性（35.4%）或紧急（34.7%）剖宫产。调整后，与年轻母亲（<25 岁）相比，年龄较大（≥30 岁）的母亲更有可能选择剖宫产而不是阴道分娩（相对风险比（RRR）2.22；95%置信区间（CI）1.28，3.84），并且在私立医院分娩（RRR 3.64；95% CI 1.79，7.38）。与接受小学或更低水平教育的女性相比，接受大学教育的女性更有可能选择选择性（RRR 2.65；95% CI 1.54，4.58）或紧急剖宫产（RRR 3.92；95% CI 2.27，6.78）而不是阴道分娩。同样，超重或肥胖的女性比健康体重的女性更有可能选择选择性（RRR 1.91；95% CI 1.27，2.87）或紧急剖宫产（RRR 2.02；95% CI 1.35，3.02）而不是阴道分娩。为了鼓励自然分娩，为产科医生和助产士提供专业教育，并向私立医院支付经济激励，可能有助于减少伊朗不必要的剖宫产。此外，为了增加她们的分娩知识和自我效能感，孕妇需要有机会参加有针对性设计的产前分娩准备课程，在那里她们可以获得有关自然分娩和替代疼痛控制方法的循证信息，以及剖宫产的风险和指征。
