Related Factors of Elective Cesarean Section: A Cue-Control Study

Objective To summarize the trend of CSR at a district public hospital in Guangzhou in the past decade and to identify patient and physician-related factors for elective cesarean section in 2009.Methods This was a case-control study. All available non-medical risk factors were collected from inpatient medical records. PS power software was used to calculate sample size. Cases were women who underwent Cesarean delivery at maternal recquest or for unclear obstetric indication and controls were women who underwent Cesarean delivery with one or more medical indications. A total sample size of 709 (348 cases and 361 controls) was obtained via stratified random sampling from 4176 in-patient delivery records in 2009.Risk factors for CS were examined in Chi-square test and logistic regression models. Results In our hospital, the total CSR increased in a linear manner from 41.8% in 2000 to 59.9% in 2009. Hour of delivery was a significant predictor for ECS. The odds of ECS were higher during normal work hours than outside normal work hours. More frequent prenatal visits were significantly associated with ECS. Conclusion In study population, women who labour during normal working hours or access to more sufficient prenatal care have higher probability to undergo ECS. These present findings suggest that obstetrician's preference involve in maternal request for elective cesarean section. Physicians' convenience incentive and fear of being sued might be the potential drivers of their preference. Therefore the controlling of elective cesarean delivery is more likely to be a process of changing obstetrician practice pattern than of patient education. Key words: Elective cesarean section;  Cesarean section;  Physician convenience incentives