Jiasong Yuen1, Ian Painter2, Linta Abraham3, Mercedes Melian4, Donna M Denno5. 1. Travel Medicine Northwest, Bellingham, USA. 2. Northwest Center for Public Health Practice, Department of Health Services, University of Washington, Seattle, USA. 3. School of Public Health, University of Washington, Seattle, USA. 4. Centro Paraguayo de Estudios de Población, Asunción, Paraguay. 5. Department of Pediatrics, University of Washington, Seattle, USA; Department of Global Health and Health Services, University of Washington, Seattle, USA. Electronic address: ddenno@u.washington.edu.
Abstract
OBJECTIVE: To identify maternal factors associated with the rise in the cesarean delivery rate in Paraguay. METHODS: Retrospective analysis of the 1995 and the 2008 National Survey on Demographic and Sexual and Reproductive Health data using multivariable logistic regression. RESULTS: In 2008, 1094 (37.3%) deliveries were cesarean compared with 781 (19.3%) in 1995. Home births had decreased by 72.9%, accounting for 33.3% of the change in the proportion of cesarean deliveries. Private facilities were associated with an increased odds ratio of cesarean delivery of 2.60 (95% confidence interval [CI], 2.02-3.34) and 4.89 (95% CI, 3.67-6.51) in 1995 and 2008, respectively, and accounted for 32.8% of the increase in cesarean deliveries between 1995 and 2008. Cesarean delivery was also associated with a prior cesarean, insurance status, and maternal higher educational and economic status. CONCLUSION: Between 1995 and 2008 the cesarean delivery rate in Paraguay almost doubled. More than one-third of deliveries were cesarean. Shifts toward facility- (particularly private) based deliveries and repeat cesarean for women with a previous cesarean influenced this increase. Practice guidelines, regulation, and oversight of facilities, along with education and information for pregnant women, are needed to curb unnecessary and potentially harmful surgical delivery interventions.
OBJECTIVE: To identify maternal factors associated with the rise in the cesarean delivery rate in Paraguay. METHODS: Retrospective analysis of the 1995 and the 2008 National Survey on Demographic and Sexual and Reproductive Health data using multivariable logistic regression. RESULTS: In 2008, 1094 (37.3%) deliveries were cesarean compared with 781 (19.3%) in 1995. Home births had decreased by 72.9%, accounting for 33.3% of the change in the proportion of cesarean deliveries. Private facilities were associated with an increased odds ratio of cesarean delivery of 2.60 (95% confidence interval [CI], 2.02-3.34) and 4.89 (95% CI, 3.67-6.51) in 1995 and 2008, respectively, and accounted for 32.8% of the increase in cesarean deliveries between 1995 and 2008. Cesarean delivery was also associated with a prior cesarean, insurance status, and maternal higher educational and economic status. CONCLUSION: Between 1995 and 2008 the cesarean delivery rate in Paraguay almost doubled. More than one-third of deliveries were cesarean. Shifts toward facility- (particularly private) based deliveries and repeat cesarean for women with a previous cesarean influenced this increase. Practice guidelines, regulation, and oversight of facilities, along with education and information for pregnant women, are needed to curb unnecessary and potentially harmful surgical delivery interventions.
Authors: Lianlian Wang; Xianglong Xu; Philip Baker; Chao Tong; Lei Zhang; Hongbo Qi; Yong Zhao Journal: Int J Environ Res Public Health Date: 2016-07-07 Impact factor: 3.390