The Prevalence and Determinants of Caesarean Section among Antenatal Mothers in Selected Hospitals, Thrissur, Kerala

Abstract

Introduction

Pregnancy is a transformative period in a woman's life, and the method of delivery—whether vaginal or Caesarean—is critical. While C-sections are life-saving in high-risk pregnancies, their increasing global prevalence has raised health and ethical concerns, especially when not medically necessary.

• C-section definition: A surgical procedure to deliver a baby through incisions in the abdomen and uterus.

• WHO recommended C-section rate: 10–15%.

• Current global rate: 21.1%, with wide regional variation.

  • India: Rose from 17.2% (2016) to 21.5% (2021).

  • Kerala (2024): 44% overall; 5 districts exceed 50%.

    • Thrissur: 46%.

2. Problem Statement

The rising C-section rate in Kerala, including in Thrissur district, suggests potential overuse, prompting the need to explore:

• Maternal factors (e.g., age, comorbidities)

• Fetal factors (e.g., distress, abnormal presentation)

• Health system factors (e.g., hospital type, protocols)

3. Study Aim and Objectives

Aim:
To assess the prevalence and determinants of Caesarean sections among antenatal mothers in selected hospitals in Thrissur, Kerala.

Objectives:

1. Determine the prevalence of C-sections in selected hospitals.

2. Identify maternal, fetal, and healthcare-related factors associated with C-sections.

3. Analyze associations between C-section determinants and sociodemographic variables.

4. Significance of the Study

• Overuse of C-sections can lead to increased risks (e.g., infections, haemorrhage, complications in future pregnancies).

• Understanding local drivers helps ensure evidence-based, medically justified C-section practices.

• Aims to inform policy decisions, clinical guidelines, and resource allocation.

5. Key Contributing Factors (Based on Literature Review)

Maternal Factors

• Advanced maternal age

• Obesity, diabetes, and other comorbidities

• Fear of vaginal birth

• Previous C-section history

Fetal Factors

• Fetal distress

• Malpresentation

• Macrosomia

• Multiple gestations

Healthcare Factors

• Type of hospital (private vs. public)

• Overuse of fetal monitoring

• Lack of standardized labor protocols

• Financial incentives for C-section

• Availability of surgical resources

Cultural & Social Factors

• Patient or family preference

• Timing of delivery around holidays/festivals

6. Key Findings from Reviewed Studies

• Rates vary widely by country and region.

• Private hospitals tend to have higher C-section rates.

• Education, socioeconomic status, and urban residence correlate with higher rates.

• Previous C-section is a major predictor for elective repeat procedures.

• Cultural influences, like preference for auspicious dates, may impact delivery timing.

7. Methodological Details

Population

• Antenatal mothers (ages 20–45) admitted for delivery between July and December 2024 in selected hospitals.

Definitions

• Prevalence: Proportion of C-sections in the study period.

• Determinants: Maternal, fetal, and health system factors influencing C-section decision-making.

Hypothesis

• Null Hypothesis (H?): No association between C-section rates and their determinants among antenatal mothers.

8. Conceptual Framework

Based on Pender’s Health Promotion Model, the study categorizes influences into:

• Individual characteristics and experiences: Maternal and fetal health conditions

• Behavior-specific cognitions and affect: Perceived benefits and barriers of C-section

• Societal and institutional factors: Cultural preferences, hospital practices, policy environment

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Copyright © 2025 Fincy Joseph P, Soja N D. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.