Prevalence and factors associated with caesarean delivery on maternal request and its effect on maternal and foetal outcomes in selected tertiary care hospital, Odisha, Southeastern India.

Abstract

Background: 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.

Methods: 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 χ² tests for univariate analysis and a logistic regression model in the multivariate analysis, to investigate the relationship between factors and mode of delivery.

Results: 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.

Conclusions: 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.