ISSN: 2474-9230
Authors: Baldes N*, Wiesel A and Queißer-Wahrendorf A
Background: In the industrialized world, the proportion of caesarean sections (CS) is increasing over time. Estimating the incidence of caesarean delivery on maternal request (CDMR) to be 7–14% of all CS today. Previous studies described advanced maternal age, increasing maternal body mass index (BMI), multiple pregnancies, breech presentation, suspected low infant birthweight and private hospital status as reasons for the overall increase. The aim of this study was to evaluate the birth mode distribution in correlation to influencing factors over time. Methods: We analysed data on CDMR of the population-based Mainz birth registry from 1990-2013. The following known exposure were considered to be relevant: maternal age, BMI, diabetes, smoking and ethnicity, assisted reproductive technologies (ART), socioeconomic status of the family, infants birthweight, and year of data collection as a proxy for unknown risk factors. A logistic regression model quantifies the impact of these factors. Results: The overall proportion of CDMR was 4.1% of all births in the study period and 17.1% of all CS. The proportion of CDMR increased from 0.8% to 4.5% as well as CS from 16.4% to 29.5% from 1990 to 2013. The logistic regression model for CDMR showed significant results for maternal age, infants birthweight >90%ile, ART, smoking mothers, BMI, and maternal diabetes. However, a large proportion of the yearly increase remains unexplained. Conclusion: Since the CDMR proportion rises over time independently from the other factors, there have to be other factors influencing the CDMR rate.
Keywords: Caesarean Delivery on Maternal Request; Elective Caesarean Section; Birth Epidemiology; Time Trend; Mode of Delivery; Birth Registry
