Background: The increasing caesarean section (CS) rates have been an issue in both developed and developing countries, but what is of concern is the fact that the growing CS rates in some countries of Latin America are as much as three times higher than WHOs recommended caesarean section rate (5-15%). As all surgical procedures, this procedure also bears its risks and therefore the indications for this mode of delivery should be absolute and present. In this analysis we want to investigate the relationship between CS and indications for this procedure, as well as whether there is a socio-demographic indicator present.
Methods:We conducted our research at a public hospital, Hospital Nacional Profesor Alejandro Posadas, in Buenos Aires, Argentina. The study is a retrospective cohort study based on data from individual data collection forms (CIP). These registration forms were provided by the Argentinean department of maternal and child health. We collected data of all CS performed as method of delivery during October 1st – November 30th 2010. This was a total of 205 CS. Data was missing on 5 of these. We chose to define the remaining 200 CS as 200 women with each having had a CS. Univariate, bivariate and multilevel analyses were performed to study the association between different groups of CS with indications and socio-demographic factors.
Results:A total of 746 deliveries were recorded at Posadas hospital and 27,5 % of these were CS. Of the 200 CS analysed 62,5 % of these were elective, 33 % were emergency and 4 % were induced. We found that while most women in our study elected to have a CS, the number was significantly higher, proportionally, among women aged 35 and over. When seen in association with the mothers’ level of education, women with education at university level had the highest rates of elective CS with 72,2 % and the lowest rates of emergency CS with 27,3 %. Married women or women in stable relationships compared to single women, had the highest rates in three of the five most common indications as 24,1 % had undergone a previous CS, 14,4 % had other indications and 8,6 % had breech presentation. Single women had consistent rates in all categories of indications ranging from 8,3 % to 16,7 %.
Conclusions:The associations between indications for caesarean section and different socio-demographic factors investigated in this study are strong and statistically significant given the small sample of study population. On the other hand the results here may not be representative for the larger population. Still we cannot disregard the clear tendencies of the study population that this study showcases. Even with a study group of only 200, our results can still be significant as they confirm previous studies that show that women who are better educated, are in stable relationships, are older, have had previous CS, and are wealthier - tend to opt for CS. Though to make any such association much stronger and representative for the population as a whole one should have had a much larger study population, preferably from more than one public hospital, and probably chosen a different study design; perhaps a cross-sectional cohort study. Lastly it is important to mention that the increasing CS rates may pose a greater problem than initially assumed and more research is needed on this issue, especially outcomes of CS, both economically and medically should be evaluated. In the future it will be necessary to reduce the tendency of choosing CS as mode of delivery in situations where the indications are not medically justified.