OBJECTIVE: to assess both clinical and non clinical factors associated with elective caesarean section practice and to highlight those typologies of expectant mothers who underwent elective caesarean delivery even in the absence of clinical risk factors. SETTING AND PARTICIPANTS: Birth Certificates archive has been used as data source: 62888 available records of all the births that occurred in the Campania region in 2005 both in public and private hospitals. Only those births pertained to women without previous caesarean sections were analyzed. MAIN OUTCOME MEASURES: type of delivery, dichotomized as elective caesarean section and vaginal delivery. RESULTS: after adjusting the data for known risk factors, elective caesarean section practice emerged as much more prevalent in private hospitals than in public ones (53.1% vs 24.3%, p<0.001). A multivariate logistic regression model showed a significant association between primiparity and elective caesarean section. This association was stronger in private hospitals (OR for interaction between parity and hospital typology 1.81, CI 95% 1.62-2.04). Being older than 34 years, having recoursed to medically assisted procreation and a previous voluntary termination of pregnancy cause an increase in the odd of resorting to elective caesarean section (p<0.01). Being foreigner, high educational qualification and young age were protective factors for elective caesarean section (respectively, OR 0.36 CI 95% 0.31-0.42, OR 0.81 CI 95% 0.77-0.86 e OR 0.84 CI 95% 0.78 -0.90). Five different typologies of primiparous women were found by means of a hierarchical classification procedure. A high percentage of elective caesarean section was found in women assisted in private structure with no clinical risk. CONCLUSIONS: in Campania there is an excess of elective caesarean sections among primiparous women without manifest clinical risk factors; this excess is higher when the delivery occurs in Private Hospitals. Public health policy and actions aimed at reducing caesarean section rates should be addressed mainly to this typology of women.
OBJECTIVE: to assess both clinical and non clinical factors associated with elective caesarean section practice and to highlight those typologies of expectant mothers who underwent elective caesarean delivery even in the absence of clinical risk factors. SETTING AND PARTICIPANTS: Birth Certificates archive has been used as data source: 62888 available records of all the births that occurred in the Campania region in 2005 both in public and private hospitals. Only those births pertained to women without previous caesarean sections were analyzed. MAIN OUTCOME MEASURES: type of delivery, dichotomized as elective caesarean section and vaginal delivery. RESULTS: after adjusting the data for known risk factors, elective caesarean section practice emerged as much more prevalent in private hospitals than in public ones (53.1% vs 24.3%, p<0.001). A multivariate logistic regression model showed a significant association between primiparity and elective caesarean section. This association was stronger in private hospitals (OR for interaction between parity and hospital typology 1.81, CI 95% 1.62-2.04). Being older than 34 years, having recoursed to medically assisted procreation and a previous voluntary termination of pregnancy cause an increase in the odd of resorting to elective caesarean section (p<0.01). Being foreigner, high educational qualification and young age were protective factors for elective caesarean section (respectively, OR 0.36 CI 95% 0.31-0.42, OR 0.81 CI 95% 0.77-0.86 e OR 0.84 CI 95% 0.78 -0.90). Five different typologies of primiparous women were found by means of a hierarchical classification procedure. A high percentage of elective caesarean section was found in women assisted in private structure with no clinical risk. CONCLUSIONS: in Campania there is an excess of elective caesarean sections among primiparous women without manifest clinical risk factors; this excess is higher when the delivery occurs in Private Hospitals. Public health policy and actions aimed at reducing caesarean section rates should be addressed mainly to this typology of women.