Determinants of caesarean delivery among women hospitalized for childbirth in a remote population in China.

OBJECTIVE

To assess determinants of a high Caesarean delivery rate in a remote population in China.

METHODS

A prospective cohort study including 20,891 women who gave birth between January 1, 1997, and June 30, 1998, in one of the 18 hospitals participating in a hospital-based regional perinatal surveillance system in Qingyuan, a remote rural region in Guangdong province, China.

RESULTS

Of the 20,891 pregnant women registered by the Qingyuan Perinatal Surveillance System, 7.5% were delivered by elective Caesarean section, and 18.4% were delivered by non-elective Caesarean section. The most common indications for elective Caesarean delivery were socio-cultural, non-medical reasons, such as the woman's fear of pain, her wish to give birth on a date or at a time believed to be particularly auspicious, or her belief that delivery by Caesarean section would protect the baby's brain. Factors strongly related to elective Caesarean delivery included insurance status, maternal age, plurality, preeclampsia and eclampsia, gestational age, and birth weight. The most common indication for non-elective Caesarean delivery was cephalopelvic disproportion. Factors strongly related to non-elective Caesarean delivery included maternal age, preeclampsia and eclampsia, placenta previa, gestational age, and birth weight.

CONCLUSION

Non-medical causes, including a woman's insurance status and her personal and social demands, accounted for a large proportion of elective Caesarean deliveries in this remote population in China.