Opting For C-section Vs Natural Delivery: Understanding Factors, Influencing Choices, Practices And Cost
Author: Muhammad Adil Khan


The Cesarean Section (CS) has become among the most common surgeries with the rates growing continuously in high and middle income countries. It has been evident from the most recent report of Pakistan Demographic and Health Survey (PDHS) that the rates of C-Section deliveries have rapidly increased from 14% in 2012-13 to 22% in 2017-18 in Pakistan. The current study aims to investigate the CS and natural delivery rates in tertiary hospitals (one public and two private) in Islamabad. We explore in this study the cost of two modes of delivery and examine the influencing factors related to the total cost of the childbirth in both CS and natural delivery. The results obtained showed that the rates of CS were 58% in public hospital and 73% in private hospitals as compared to natural delivery. CS rates were found to be high along with the associating factors such as women with high maternal age (>24 years), high socioeconomic class, women with high education and professionally stable and preference of private facility. The indications with higher frequency comes out to be abnormal /breached baby position, prolonged labor & failed Induction along with fetal distress and high BP/gestational diabetes and previous C-section, over age and psychological fear of natural delivery process for elective CS, emergency CS and CS on demand respectively. The cost and length of stay of CS were greater than those of natural delivery with significant difference (p< 0.05). The variables such as age and length of stay were the influencing factors for both CS and normal delivery costs which had the value p>F= 0.0291 which is less than 0.05 for public hospital and value p>F= 0.04 which is less than < 0.05 for private hospitals. Thus, comprehending that the CS rates were high than natural delivery in both public and private hospitals with the major factors significantly impacting the total cost comes out to be age and length of stay. It is therefore recommended that an upsurge in the overall CS rates needs to be controlled by implementation of strict departmental guidelines, design & development of comprehensive policies and design & implementation of community based programs.

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Supervisor: Amena Urooj
Cosupervisor: Fazal-e-Hakim Khattak

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