Factors Influencing Caesarean Deliveries at the 37 Military Hospital, Accra: A Cross-Sectional Study.

Abstract

Background: Caesarean section remains a life-saving obstetric intervention that can effectively be prioritized to prevent maternal and neonatal mortality. The WHO recommends a caesarean section threshold of between 10% to 15%. This study sought to determine the maternal factors that influenced the preference for caesarean deliveries among antenatal mothers at the 37 Military Hospital in the Greater Accra region of Ghana. Methods: A cross-sectional study design was conducted. The study purposively sampled antenatal mothers within their third trimester of pregnancy. Health workers were also purposively included to determine their perspectives of caesarean section. Semi-structured questionnaires were used to collect data from the antenatal mothers as well as the health workers. The study also reviewed the delivery registers at the facility from 2017 to 2021 to determine the prevalence and trend of caesarean section at the hospital. Logistic regression analyses were used to determine the factors that influenced caesarean deliveries at the hospital (significant at α=0.05). Results: A total of 409 antenatal mothers and 29 health workers participated in the study. The mean age of the mothers was 31 years. The study revealed an average caesarean prevalence rate of 50.3% from 2017 to 2021. From the study, 27.1% and 72.9% of the antenatal mothers preferred caesarean section and vaginal delivery respectively. Maternal reasons for preferring caesarean section were safe and less painful (48.6%), previous CS (41.4%) and health reasons (10%). In addition, 67.2% of women had adequate knowledge and 75.1% and 57.2% had positive attitudes and good perceptions about caesarean section respectively. Also, majority of health workers had good perceptions on caesarean section. The study showed that the history of emergency (AOR: 12.29, p<0.0001) and elective (AOR:48.35, p<0.0001) caesarean section among antenatal mothers significantly influenced their preference for caesarean section at the hospital. In addition, ANC mothers with gravida two (AOR= 0.21, p=0.037) were more likely to prefer a CS delivery to those with their first pregnancy. Conclusion: Although, the level of caesarean section election and preference among pregnant women is considerably high, the main influencing factors were having a history of caesarean delivery and the number of pregnancies of ANC mothers. Women should be adequately counselled for opting for vaginal delivery when it is possible. The hospital should adopt pragmatic steps to sustain the decline of CS election among pregnant women.