Epidemiology of Caesarean section on maternal request in Australia: A population-based study

Objective: To explore the trends, determinants, and short-term maternal and neonatal health outcomes of Caesarean section on maternal request (CSMR).Design: Population-based record linkage study.Setting: Birth registry data for all births in Queensland, Australia, from 2008 to 2017.Participants: Pregnancies resulting in live or intrapartum stillbirth with > = 20 gestational weeks and/or > = 400 gm birth weight were the study population. The analytic sample was restricted to low-risk preg-nancies by excluding preterm, non-cephalic pregnancies with medical risk factors.Measurements: CSMR was defined as a first-time C-section in singleton, term pregnancies with an ICD-10-AM code of O-82/O-47. CSMR trend was reported in age-standardised rate using a join-point regression model. The determinants and perinatal outcomes of CSMR were tested against Spontaneous vaginal births (VBs) and planned VBs including assisted VBs and emergency C-sections in this group. The generalised estimating equation technique was used for regression analysis and reported in the odds ratio (OR) at a 95% Confidence Interval (CI).Findings: Of total C-sections ( n = 204,863), the average annual change in CSMR rate was 4.4% (95% CI: 2.1-6.7%, p < 0.01) for the total pregnancies (N = 613,375) Of the analytic sample (N = 365568 ), nulliparous women with age >= 35 years (OR: 2.32,95% CI: 2.09-2.57), delivered at private hospitals (OR:4.90; 95% CI: 4.65-5.18); with mood disorders (OR: 2.15; 95% CI: 1.88-2.43) were positive and midwives birth attendant (OR 0.28; 95% CI: 0.26 to 0.30) was negative influencing factors for CSMR. In a propensity score matched sample; CSMR observed an increasedrisk of anaesthetic complications (OR: 8.00; 95% CI:1.95-32.82) and slightly reduced odds of birth asphyxia (OR:0.20;95%CI:0.06-0.60)against planned VBs while the overall incidence of birth-asphyxia was low (1.29%) However, neonatal morbidities (OR:1.61; 95% CI:1-2.59) and special care admission (OR:2.15; 95% CI:1.03-4.5) were higher after CSMR in comparison to SVBsConclusion: Despite being linked with adverse perinatal health outcomes, the incidence of CSMR in-creased 1.75-fold during the past 10 years. Maternal educational interventions to provide adequate infor-mation, including the long-term risks and benefits of C-sections, can help reduce the growing rates of CSMR.(c) 2022 Published by Elsevier Ltd.

Automated summary

This population-based record linkage study in Queensland, Australia, examined the trends, determinants, and short-term maternal and neonatal health outcomes of Caesarean section on maternal request (CSMR). The findings showed that the incidence of CSMR has increased 1.75-fold over the past 10 years and is associated with adverse perinatal health outcomes. Maternal educational interventions providing adequate information about the long-term risks and benefits of C-sections are needed to reduce the rising rates of CSMR.