Socioeconomic, Maternal, Neonatal and Health System Determinants of the <span lang="EN-GB">Choice<span lang="EN-GB"> <span lang="EN-GB">of Delivery Mode in Tehran Province: A Cross-sectional Study

Background & aim: Cesarean section (CS) is a life-saving intervention in specific obstetric situations, yet it has become one of the most frequently performed surgical procedures, globally. This study investigated socioeconomic, maternal, neonatal, and health system determinants influencing the choice of delivery mode in Tehran, Iran. Methods: The study included ۴۰۰ mothers who had given birth during the study period and were selected using stratified sampling based on urban and rural population distribution. This study was conducted in healthcare facilities across Tehran Province between March ۲۰۲۳ to March ۲۰۲۴. Data were collected using a researcher-developed questionnaire. The questionnaire included questions on participants’ demographic, socioeconomic, maternal, and obstetric characteristics, as well as their mode of delivery. The questionnaire was completed by eligible mothers after obtaining informed consent. Given the binary nature of the outcome (delivery mode), data were analyzed using Chi-square and Mann–Whitney U tests, followed by penalized binary logistic regression in Stata ۱۷.Results: The overall CS rate was ۶۲%. Penalized logistic regression analysis showed that women aged >۳۱ years had significantly higher odds of cesarean delivery (OR = ۴.۰۲; ۹۵% CI: ۱.۴۹–۱۰.۸۷; P = ۰.۰۰۶). Maternal employment in the public sector was also associated with increased odds of CS (OR = ۴.۵۰; ۹۵% CI: ۱.۶۶–۱۲.۲۲; P = ۰.۰۰۳), as was having supplementary health insurance (OR = ۲.۰۱; ۹۵% CI: ۱.۱۰–۳.۶۸; P = ۰.۰۲۳). In contrast, a history of stillbirth (OR = ۰.۰۶; ۹۵% CI: ۰.۰۱–۰.۴۸; P = ۰.۰۰۸), participation in prenatal birth-preparation classes (OR = ۰.۴۱; ۹۵% CI: ۰.۲۴–۰.۶۹; P = ۰.۰۰۱), and delivering in public hospitals or at home compared to private hospitals (OR = ۰.۳۰; ۹۵% CI: ۰.۱۶–۰.۵۶; P < ۰.۰۰۱) were associated with lower odds of cesarean delivery.Conclusion: These findings highlight the multifactorial nature of maternal choice of delivery mode and underscore the importance of strengthening maternal education, improving access to supportive prenatal services, and developing evidence-based policies to promote appropriate delivery practices.

کلیدواژه ها:

Cesarean section ، Natural Childbirth ، Maternal health ، prenatal care ، Socioeconomic factors