Caesarean Delivery in South Italy: Women without Choice. A Cross Sectional SurveyReport as inadecuate




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Background

In spite of the World Health Organization’s recommendations to maintain caesarean delivery CD between 5% and 15% of total births, the rates of CD continue to rise in countries with routine access to medical services. As in Italy CD rate reached 38% in 2008, the highest at EU level, we evaluated socioeconomic and clinical correlates of -elective- and -non programmed- CD in the Country. We performed a stratified analysis in order to verify whether the effect of such correlates differed among women with an -a priori- preference for natural and caesarean delivery respectively.

Methods and Findings

We analyzed cross-sectional data from the Italian National Statistics Institute ISTAT survey on health condition. Socio-demographic variables, information on maternal care services use and health conditions during pregnancy, as well as maternal preferences on delivery, were available for a representative sample of 2,474 primiparous women. After an initial bivariate analysis, we used logistic regressions to evaluate factors associated to the study outcomes. Overall CD accounted for 35.5% of the total births in our sample CI 33.6–37.4%; moreover, 30.7% CI 28.6–32.6% of women preferring natural delivery actually delivered with a CD. Elective CD rate is higher among women over 35 years 22.9%, CI 18.8–27.4%, and those living in the South 26.2%, CI 23.0–29.6%. The multivariate analysis showed that, even adjusting for several confounders, women in the South, receiving care in the private sector had higher chances of CD, also in case of preference for natural delivery.

Conclusion

Policy interventions are required to reduce the rate of undesired CD, e.g. increasing women knowledge regarding delivery in order to favour aware choices. An effective strategy to reduce CD rate should address the Southern Regions, as women here appear to have a very limited control over the delivery, in spite of a widespread preference for natural delivery.



Author: Pamela Barbadoro, Carlos Chiatti, Marcello Mario D’Errico, Francesco Di Stanislao, Emilia Prospero

Source: http://plos.srce.hr/



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