Assessment of prevalence, perceptions, and factors associated with reported history of caesarean section among women in the United Arab Emirates: a cross-sectional study.

BACKGROUND

Caesarean section (CS) is a life-saving intervention when medically indicated; however, its use has increased substantially worldwide, including in high-access healthcare settings. Emerging evidence suggests that women's perceptions, prior childbirth experiences, and counselling practices may contribute to persistently elevated CS rates. This study assessed the prevalence of reported history of CS and examined sociodemographic, health-system, and perception-related factors associated with prior CS among women in the United Arab Emirates (UAE).

METHODS

A cross-sectional questionnaire-based survey was conducted among women aged ≥ 18 years residing in the UAE between February and October 2025. Data were collected using a structured self-administered questionnaire assessing sociodemographic characteristics, obstetric history, delivery-related perceptions, and factors influencing decision-making regarding mode of delivery. Analyses examining CS history were restricted to women with at least one prior delivery, and the outcome was defined as reporting at least one previous CS. Descriptive statistics, chi-square tests, and multivariable binary logistic regression analyses were performed. Separate domain-specific regression models and an additional combined multivariable model were constructed to assess potential confounding between sociodemographic and perception-related variables.

RESULTS

Among 351 women with previous deliveries, 219 (62.4%) reported a history of at least one CS. The most commonly reported reasons for CS included foetal medical indications (28.3%), healthcare provider recommendation (18.7%), perceived foetal safety (18.7%), and fear of labour pain (16.0%). In the combined multivariable model, age ≥ 31 years (AOR 1.73; 95% CI 1.06-2.81) and undergraduate/postgraduate educational attainment (AOR 2.04; 95% CI 1.13-3.69) were independently associated with prior CS. Perception-related variables associated with prior CS included disagreement that vaginal delivery leads to better maternal recovery (AOR 18.50; 95% CI 2.37-144.51), disagreement that vaginal birth promotes better mother-baby bonding (AOR 2.37; 95% CI 1.28-4.38), and the belief that CS impacts infant immune outcomes (AOR 2.57; 95% CI 1.35-4.90). Women identified improved counselling from healthcare providers as the most important factor perceived to support better delivery-related decision-making.

CONCLUSIONS

A reported history of CS was high within this UAE study sample. While most sociodemographic and health-system characteristics demonstrated limited independent association with prior CS, selected perception-related and experiential factors remained associated after adjustment. These findings suggest that in high-access healthcare settings, communication- and perception-related influences may contribute meaningfully to delivery-related preferences and experiences. Strengthening balanced, evidence-based, and woman-centred antenatal counselling may support informed decision-making regarding mode of delivery.