Factors associated with caesarean sections in Phnom Penh, Cambodia

Abstract

C-sections are an increasingly performed medical practice which can save lives but may also lead to major complications. Through a mixed methods study conducted in 2015 in Cambodia, we aimed to analyze the reasons for requesting a c-section and to explore factors that are associated with c-sections. 60% of the women in the cohort who gave birth by c-section reported having requested it. Through 31 in-depth interviews, we determined the reasons given by women for requesting a c-section before and during labour. Before labour, reasons for requesting a c-section were: choosing the delivery date; bringing luck and joy to the family; protecting the genitals, and the belief that c-section is safer for the mother and for the baby. Reasons given during labour were fear, pain, and having no more energy. We also observed two major factors driving the women's request for a c-section: family support for requesting a c-section, and the overusage of ultrasound examinations. Our multivariate analysis of the interviews of 143 women before and after delivery showed that having a previous c-section, delivering in a private facility, being older than median at the time of sexual debut, residing outside of Phnom Penh and having the delivery costs covered by the family were all factors independently and significantly associated with a higher chance of c-section delivery. We conclude that women are not well informed to give consent for c-delivery, and that their request is often affected by false belief and poor knowledge.

Reasons for Increased Caesarean Section Rate in Vietnam: A Qualitative Study among Vietnamese Mothers and Health Care Professionals

“…Most of these social factors identified in our study were commonly observed across multi-countries worldwide: fear of childbirth [14,[22][23][24][25][26][27][28], lack of self-efficacy for childbirth [22,29,30], and belief that CS is superior to vaginal delivery [10,14,[31][32][33], wealthier family [7,13], and private hospital [14,34]. Additionally, determinants of decision making such as a belief that CS is a part of a woman's autonomy [10,14,35], the strong impact by media [19,36], and/or family and friends [14,19,22,29,37] are consistent with previous studies.…”

Interventions to reduce unnecessary caesarean sections in healthy women and babies

“…19,26,33 In some settings, there are perceived advantages for the child of an auspicious birthdate. 18,24,28,34 Previous negative experiences of vaginal birth, including suboptimal quality of care, and experiences of disrespect and abuse, also influence choice for CS birth in subsequent pregnancies. 23,[35][36][37] Contemporary society exposes pregnant women to a wide range of information on pregnancy and childbirth.…”

“…In settings where obstetricians combine public and private work, scheduling elective CSs allows for private work to be reconciled with public duties. 34,53,57 Factors related to healthcare systems, financial reimbursements, and organisational…”

Magnitude and Correlates of Caesarean Section in Urban and Rural Areas: A Multivariate Study in Vietnam

“…Similarly, a study using data from 29 countries in Asia, Africa and Latin America showed higher CS rates in urban areas than in periurban areas (18). Conversely, a study in Cambodia showed that CS rates were lower for women living in Phnom Penh than for women living in its surrounding area (19).…”