Singh Sindhu, Swain Dharitri
J Glob Health. 2025 Mar 21;15:04073. doi: 10.7189/jogh.15.04073.
Caesarean delivery is now predominantly performed in response to the mother's request, often without medical indications, commonly referred to as caesarean delivery on maternal request (CDMR). The rise in CDMR has become a significant issue in maternal and newborn health. We aimed to explore the factors influencing CDMR and its effect on maternal and foetal outcomes.
We used a prospective cohort design approach to recruit 413 participants and a consecutive sampling technique to select the participants. Those who fulfilled the inclusion criteria were taken during the six-month data collection period from October 2023 to March 2024. We used a structured interview method for data collection. We utilised inferential statistics, such as Fisher exact and χ tests for univariate analysis and a logistic regression model in the multivariate analysis, to investigate the relationship between factors and mode of delivery.
The multivariate regression analysis revealed that the CDMR rate was higher among the women who preferred caesarean delivery before giving birth (odds ratio (OR) = 6.295; 95% confidence interval (CI) = 1.468-26.995, P < 0.05). Additionally, women with a history of previous caesarean delivery were more inclined to choose CDMR in the subsequent pregnancy (OR = 25.642; 95% CI = 1.199-548.221, P < 0.05). The likelihood of experiencing wound pain (OR = 42.374; 95% CI = 14.612-122.887, P < 0.05), encountering breastfeeding difficulties (OR = 11.469; 95% CI = 2.91-45.2, P < 0.05), and neonatal intensive care unit admissions (OR = 0.268; 95% CI = 0.076-0.95, P < 0.05) was significantly higher in CDMR compared to normal vaginal delivery.
The prevalence of CDMR was 21.35%, which was relatively higher than the World Health Organization's recommended guidelines. The previous mode of delivery and maternal preference for caesarean birth were the factors that influenced CDMR. It is necessary to make childbirth readiness counselling a regular practice to assist women in selecting the best delivery method.
剖宫产现在主要是应产妇要求进行，通常没有医学指征，通常称为产妇要求剖宫产（CDMR）。CDMR的增加已成为孕产妇和新生儿健康领域的一个重大问题。我们旨在探讨影响CDMR的因素及其对孕产妇和胎儿结局的影响。
我们采用前瞻性队列设计方法招募了413名参与者，并采用连续抽样技术选择参与者。符合纳入标准的参与者是在2023年10月至2024年3月的六个月数据收集期间选取的。我们采用结构化访谈方法进行数据收集。我们利用推断统计，如用于单变量分析的Fisher精确检验和χ检验，以及多变量分析中的逻辑回归模型，来研究因素与分娩方式之间的关系。
多变量回归分析显示，在分娩前倾向于剖宫产的女性中，CDMR率更高（优势比（OR）=6.295；95%置信区间（CI）=1.468 - 26.995，P<0.05）。此外，有剖宫产史的女性在随后的妊娠中更倾向于选择CDMR（OR = 25.642；95%CI = 1.199 - 548.221，P<0.05）。与正常阴道分娩相比，CDMR产妇经历伤口疼痛（OR = 42.374；95%CI = 14.612 - 122.887，P<0.05）、遇到母乳喂养困难（OR = 11.469；95%CI = 2.91 - 45.2，P<0.05）以及新生儿入住重症监护病房（OR = 0.268；95%CI = 0.076 - 0.95，P<0.05）的可能性显著更高。
CDMR的发生率为21.35%，相对高于世界卫生组织的推荐指南。既往分娩方式和产妇对剖宫产的偏好是影响CDMR的因素。有必要将分娩准备咨询作为常规做法，以帮助女性选择最佳分娩方式。
