Factors associated with high caesarean section rates in Bertha Gxowa Hospital

Abstract

BACKGROUND: Bertha Gxowa hospital, like other district hospitals in South Africa offers Caesarean section as an essential obstetric service to pregnant women. Caesarean section rates have been increasing worldwide, giving cause for concern because of increased maternal and perinatal morbidity and mortality associated with high Caesarean section rates. This study aims to describe factors associated with high Caesarean section rates in Bertha Gxowa hospital. The researcher hypothesized that associated factors could be identified, and if demographic obstetric and non obstetric factors are described in relation to the context in which the Caesarean sections took place, it should be possible to identify significant modifiable factors. It is hoped that the findings of this study will help to shape local obstetric policy and practice, and lead to improved maternal and perinatal health. METHODS: This study utilized a quantitative cross sectional descriptive design. Patient records were reviewed to obtain information on Caesarean deliveries performed between January and December 2011. Demographic, obstetric and non obstetric factors were described. Pearson’s Chi-square, Fisher’s exact and Student t tests were used as tests of association between independent variables and Caesarean section. A logistic regression model was used to describe risk factors associated with Caesarean section. RESULTS: The results show that increasing parity was associated with Caesarean section (P = 0.004). Eighty six percent of the Caesarean sections were emergency Caesarean sections and 65% were primary Caesarean sections. The commonest obstetric indications were fetal distress, previous Caesarean section, cephalopelvic disproportion, poor progress and malpresentation. Women belonging to Robson classes 1 and 5 had more Caesarean sections than other classes. There was a significant association between Medical Officers and Caesarean section (P=0.001). There was no significant association between patient’s demand, HIV status, Medical Officers’ experience and Caesarean section. CONCLUSION: Obstetric indications contributed more to the high Caesarean sections in Bertha Gxowa hospital than non obstetric factors. The Caesarean section rates may be reduced if obstetric protocols are implemented for certain classes of patients. LEVEL OF EVIDENCE: III