Cesarean section (CS) is one of the most commonly performed surgical procedures worldwide and plays a critical role in reducing maternal and neonatal morbidity and mortality when medically indicated. However, global cesarean section rates have increased substantially over the past two decades, often exceeding the levels recommended for optimal maternal and neonatal outcomes. Understanding the factors contributing to rising cesarean section rates is essential for improving obstetric care and promoting evidence-based delivery practices.

Objective

This study aimed to identify maternal, fetal, clinical, socioeconomic, and healthcare system factors associated with cesarean section deliveries and evaluate their impact on cesarean section rates.

Methods

A retrospective multicenter observational study was conducted involving 6,200 women who delivered in tertiary healthcare facilities between 2018 and 2024. Demographic characteristics, obstetric history, clinical indications, healthcare utilization patterns, and delivery outcomes were analyzed. Multivariate logistic regression was used to identify independent predictors of cesarean section delivery.

Results

The overall cesarean section rate was 34.8%. Major predictors included previous cesarean section (OR=5.6), fetal distress (OR=4.1), maternal obesity (OR=3.3), advanced maternal age (OR=2.8), multiple gestation (OR=2.6), labor induction (OR=2.3), and private healthcare utilization (OR=1.9). Non-medical factors, including maternal preference and healthcare provider practices, also contributed significantly to increased cesarean section rates.

Conclusion

Both clinical and non-clinical factors influence cesarean section rates. Strategies promoting appropriate use of cesarean delivery, patient education, labor management optimization, and evidence-based obstetric practices are essential for reducing unnecessary cesarean sections while maintaining maternal and neonatal safety.