Determinants of caesarian birth on maternal demand in the Islamic Republic of Iran: a review

Abstract

Analyse des déterminants des naissances par césarienne sur demande de la mère en République islamique d'IranRÉSUMÉ Le phénomène des naissances par césarienne sur demande fait l'objet de discussions, notamment parce qu'une première césarienne est hautement prédictive d'autres césariennes lors des naissances suivantes. L'identification des raisons d'un accouchement par césarienne sur demande est importante de façon à planifier des interventions efficaces. À ce titre, la présente analyse fait état, sur la base d'études menées en République islamique d'Iran, des facteurs impliqués dans la tendance qu'ont les femmes de recourir à un accouchement par césarienne. Plusieurs mots clés incluant « naissance par césarienne », « accouchement », « causes », « demande/ exigence de la mère », ainsi que « choix de la patiente » ont été utilisés pour effectuer des recherches dans Medline, PubMed, Ovid, Scientific Information Database, Magiran, Google et Google Scholar. La recherche a été menée à partir d'articles en persan et en anglais, sans limitation de temps. À l'aide d'une analyse de contenu, les facteurs influençant le recours à une césarienne ont été divisés en trois catégories : les facteurs liés à la mère, les facteurs sociaux, et ceux liés aux dispensateurs de soins. Eu égard à la prévalence élevée de césariennes, il est important de concevoir et de mettre en oeuvre des programmes et des interventions efficaces prenant en compte les raisons principales qui conduisent les femmes à opter pour une césarienne non nécessaire. ABSTRACT The phenomenon of caesarean birth on demand has gained attention, particularly as a first caesarean birth appears to be strongly predictive of subsequent caesareans. Identification of reasons behind caesarean birth on demand is important for planning effective interventions. Therefore, this review reports the factors involved in the tendency of women to undergo caesarean birth, based on studies in the Islamic Republic of Iran. Several keywords including caesarean delivery, childbirth, causes, maternal request/demand, and patient choice were used to search Medline, PubMed, Ovid, Scientific Information Database, Magiran, Google and Google Scholar. The search was conducted on Persian and English language articles, with no time limitation. Using content analysis, the factors influencing caesarean section were divided into 3 categories: maternal, social and healthcare giver. According to the high prevalence of caesarean section, it is important to design and implement effective programmes and interventions with consideration of the key reasons that lead women to opt for unnecessary caesarean section.

Incidence and Determinants of Caesarean Section in Shiraz, Iran

“…In this study, while there was no association with maternal age and emergency CS, compared to younger mothers aged less than 25 years, women aged 25 years and older were more than twice as likely to undergo an elective CS than deliver vaginally. This finding was independent of parity and is consistent with other Iranian studies, which have reported that the rate of CS increases steadily with maternal age [ 11 , 13 , 21 ].…”

“…In this study, women educated to primary or lower secondary level were less likely to undergo either an elective or emergency CS than university educated women. This association has been reported consistently in other Iranian studies [ 11 , 13 , 21 ], and there are a number of probable reasons why less educated woman are more likely to deliver vaginally. Less educated women may come from more traditional backgrounds where vaginal delivery has been the norm in their family and community and, therefore, they may have more positive attitudes towards natural childbirth, or alternatively, they may be fearful of surgery.…”

“…As a consequence, women’s attitudes and beliefs about childbirth are influenced by normative beliefs [ 4 ], and their preference for CS is largely informed by their mother, relatives, and friends who may share negative natural childbirth stories and positive CS stories [ 26 ]. Several qualitative studies have investigated the reasons why Iranian women request CS, and these primarily include fear of childbirth (labour pain, injury to mother or infant) and the belief that CS is a safer mode of delivery and that vaginal delivery carries increased risk of complications (vaginal prolapse, urinary incontinence, sexual dysfunction) [ 4 , 13 , 26 ]. These same views are often held and promoted by obstetricians who describe vaginal deliveries as time consuming and unpredictable, with obstetricians preferring to perform a CS because they perceive them to be safer and that they have more control over the process [ 3 , 27 ].…”

“…Advanced maternal age, grand multiparity, obesity, and gestational diabetes are biomedical risk factors associated with an increased likelihood of CS in general [ 7 , 8 , 9 , 10 ], while in Iran and other low and middle-income countries, socio-demographic determinants include maternal education, workforce participation, and socio-economic status [ 11 , 12 , 13 , 14 , 15 , 16 ].…”

Predictors of birth satisfaction among Iranian postpartum women: a cross-sectional study

“…Increased maternal request for cesarean [4] and its high rate [5] in recent decades in Iran has turned into a challenging public health issue. At the same time, the total fertility rate (TFR) has been declining since 1992, falling to 1.8% in 2005 and remaining close to that level since then [6,7].…”