Abstract
Background Caesarean section (CS) rates in women experiencing stillbirth have not been studied with nationally representative data. Two Ghana Maternal Health Surveys (GMHS) have captured pregnancy and mode of birth data for all women including those with stillbirths. We compared CS rates between women with live births and stillbirths, and identified socio-economic and pregnancy-related factors associated with CS in stillbirths. Methods A population-based cross-sectional study was conducted in a pooled sample of 17 138 women who had given birth within 5 years preceding the 2007 and 2017 GMHS. CS rates were compared between women with stillbirths and very early neonatal deaths (SBVENDs) and women with live births who survived the first day. Bivariate and multivariable logistic regressions explored variables associated with CS. Effect modification of household's wealth and maternal educational level by birth outcome was assessed using multivariable logistic regression with interaction terms. Results CS rate in women with SBVEND was 19.3% compared with 9.6% in women with live births who survived the first day (rate ratio 2.2; 95% CI 1.6 to 2.9). In multivariable analysis, attaining middle school compared with no formal education (adjusted OR, aOR 2.8; 95% CI 1.1 to 7.1), having had five or more births compared with nulliparity (aOR 3.7; 95% CI 1.3 to 10.7) and reporting prolonged or obstructed labour (aOR 3.3; 95% CI 1.3 to 8.3) were associated with CS in women with SBVEND. Higher household wealth and educational levels were associated with an increased risk of CS in both study groups, with no statistically significant difference in effect. Conclusion Disaggregating CS rates by birth outcome revealed a high rate among women with SBVEND, twice the overall rate compared with live births. Exclusion of these 'hidden' CSs from rate calculations may lead to underestimation of (inter)national CS rates and potentially conceals CS overuse or misuse.
| Original language | English |
|---|---|
| Article number | e011591 |
| Pages (from-to) | 1-13 |
| Number of pages | 13 |
| Journal | BMJ global health |
| Volume | 8 |
| Issue number | 6 |
| Early online date | 1 Jun 2023 |
| DOIs | |
| Publication status | Published - Jun 2023 |
Bibliographical note
Funding Information:SZ received a grand for this project from the Foundation 'De Drie Lichten' in The Netherlands. The other authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. AC is funded by the Research Foundation—Flanders (FWO) for a postdoctoral fellowship (number 1294322N).
Publisher Copyright:
© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Funding
SZ received a grand for this project from the Foundation 'De Drie Lichten' in The Netherlands. The other authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. AC is funded by the Research Foundation—Flanders (FWO) for a postdoctoral fellowship (number 1294322N).
| Funders | Funder number |
|---|---|
| Fonds Wetenschappelijk Onderzoek | 1294322N |
| Fonds Wetenschappelijk Onderzoek |
Keywords
- cross-sectional survey
- indices of health and disease and standardisation of rates
- maternal health
- obstetrics
- surgery