Assessing the Factors Affecting Cesarean Section Selection in Ira-nian Women Using Multilevel Count Models with Excess Zeros
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Abstract
Background: Iran has ranked second in the frequency of cesarean delivery (CD) and this rate in 2014 has increased by 56 percent. The CD has multiple complications for the woman and newborn, and due to the women's readmission after surgery impose additional costs to the countries. Although CD has many complications and is not recommended by obstetrician and midwives; some factors affect the choice of this method of delivery.
Methods: We used data from the Iranian Institute for Health Sciences Research (IIHSR) in 2015. We studied the effects of factors such as socioeconomic and demographic factors and supplemental insurance status in the choice of CD. We used multilevel Zero-Inflated models for the modeling of data.
Results: The employed women resident in urban areas with the high-income and age greater than 34-yr old and supplemental insurance more likely chose CD. On the other hand, women with high education level, women who use at least one media (e.g. Radio, television, etc.) and women that use contraceptive methods have chosen the less CD.
Conclusion: Our findings highlighted the importance of supplemental insurance and socio-economic status in choosing a CD by women. However, in some cases especially in the rich class of society, the high cost of this type of delivery does not affect the choice decrease of it, and governments should adopt rigorous policies in using this method.
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2. Lumbiganon P, Laopaiboon M, Gülmezoglu AM , et al (2010). Method of delivery and pregnancy outcomes in Asia: the WHO global survey on maternal and perinatal health 2007-08. Lancet, 375(9713): 490-9.
3. Villar J, Valladares E, Wojdyla D, et al (2006). Caesarean delivery rates and pregnancy outcomes: the 2005 WHO global survey on maternal and perinatal health in Latin America. Lancet, 367(9525): 1819-29.
4. Laws PJ, Sullivan DE, Grayson N (2004). Australia's mothers and babies 2007: AIHW National Perinatal Statistics Unit Sydney, NSW, Australia.
5. Tranquilli AL, Giannubilo SR (2004). Cesarean delivery on maternal request in Italy. Int J Gynaecol Obstet, 84(2): 169-70.
6. Gibbons L, Belizán JM, Lauer JA, et al (2010). The global numbers and costs of additionally needed and unnecessary caesarean sections performed per year: overuse as a barrier to universal coverage. Bull World Health Organ, 30:1-31.
7. Rafati F, Rafati S, Madani A, et al (2014). Related factors to choose cesarean section among Jiroft pregnant women. Journal of Prrventive Medicine 1(1): 23-30.
8. Amu O, Rajendran S, Bolaji II (1998). Maternal choice alone should not determine method of delivery. BMJ, 463-465.
9. Alimohamadian M, Shariat M, Mahmoudi M, Ramazanzadeh F (2003). The influence of maternal request on the elective cesarean section rate in maternity hospitals in Tehran, Iran. Payesh, 2(2): 137-142.
10. Ecker JL (2004). Once a pregnancy, always a cesarean? Rationale and feasibility of a randomized controlled trial. Am J Obstet Gynecol, 190(2):314-8.
11. Mylonas I, Friese K (2015). Indications for and risks of elective cesarean sec-tion. Dtsch Arztebl Int, 112(29-30):489-495.
12. Villar J, Carroli G, Zavaleta N, et al (2007). Maternal and neonatal individual risks and benefits associated with caesarean delivery: multicentre prospective study. BMJ, 335(7628):1025.
13. Al‐Kadri H, Sabr Y, Al‐Saif S, et al (2003). Failed individual and sequential instrumental vaginal delivery: contributing risk factors and maternal–neonatal complications. Acta Obstet Gynecol Scand, 82(7):642-8.
14. Khooshideh M, Mirzarahimi T (2017). The Comparison of Maternal and Neonatal Outcomes of Normal Vaginal Delivery versus Unplanned Cesarean Section De-livery. J Ardabil Univ Med Sci,17(1): 122-132.
15. Bodner K, Wierrani F, Grünbrger W, Bodner-Adler B (2011). Influence of the mode of delivery on maternal and neonatal outcomes: a comparison between elective cesarean section and planned vaginal delivery in a low-risk obstetric population. Arch Gynecol Obstet, 283(6): 1193-8.
16. O’Neill SM, Kearney PM, Kenny LC, et al (2013). Caesarean delivery and subsequent pregnancy interval: a systematic review and meta-analysis. BMC Pregnancy Childbirth, 13: 165.
17. Declercq E, Barger M, Cabral HJ, et al (2007). Maternal outcomes associated with planned primary cesarean births compared with planned vaginal births. Obstet Gynecol, 109(3): 669-77.
18. Smith GC, Pell JP, Bobbie R (2003). Caesarean section and risk of unexplained stillbirth in subsequent pregnancy. Lancet, 362(9398): 1779-84.
19. Lydon-Rochelle M, Holt VL, Easterling TR, Martin DP (2001). First-birth cesarean and placental abruption or previa at second birth(1). Obstet Gynecol, 97: 765-9.
20. Azami-Aghdash S, Ghojazadeh M, Dehdilani N, Mohammadi M (2014). Prevalence and causes of cesarean section in Iran: systematic review and meta-analysis.
Iran J Public Health, 43(5) :545-555.
21. Pang SM, Leung DT, Leung T, et al (2007). Determinants of preference for elective caesarean section in Hong Kong Chinese pregnant women. Hong Kong Med J, 13(2): 100-5.
22. Fenwick J, Staff L, Gamble J, et al (2010). Why do women request caesarean section in a normal, healthy first pregnancy? Midwifery, 26(4): 394-400.
23. Fuglenes D, Aas E, Botten G, Øian P, Kristiansen IS (2011). Why do some pregnant women prefer cesarean? The influence of parity, delivery experiences, and fear. Am J Obstet Gynecol, 205(1):45.e1-9.
24. Schneider F, Winn H (2000). Cesarean section and vaginal birth after cesarean section. In: Clinical maternal. New York, Parthenon Press, 15-18.
25. Ronsmans C, Holtz S, Stanton C (2006). Socioeconomic differentials in caesarean rates in developing countries: a retrospective analysis. Lancet, 368(9546): 1516-23.
26. Mi J, Liu F (2014). Rate of caesarean section is alarming in China. Lancet, 383(9927): 1463-1464.
27. Hsu K-H, Liao P-J, Hwang C-J (2008). Factors affecting Taiwanese women's choice of cesarean section. Soc Sci Med, 66(1): 201-9.
28. Leone T, Padmadas SS, Matthews Z (2008). Community factors affecting rising caesarean section rates in developing countries: an analysis of six countries. Soc Sci Med, 67(8): 1236-46.
29. Steele F, Diamond I, Wang D (1996). The determinants of the duration of contraceptive use in China: A multilevel multinomial discrete-hazards mdeling approach. Demography, 33(1): 12-23.
30. Moghimbeigi A (2011). A score test for extra zeros in negative binomial mixed models. Journal of Statistical Computation and Simulation, 81(5): 635-44.
31. Moghimbeigi A, Eshraghian MR, Moham-mad K, McArdle B (2009). A score test for zero-inflation in multilevel count data. Computational Statistics & Data Analysis, 53(4): 1239-1248.
32. Cai W-W, Marks JS, Chen C, et al (1998). Increased cesarean section rates and emerging patterns of health insurance in Shanghai, China. Am J Public Health, 88(5): 777-80.
33. Lamaz B (1998). Socioeconomic status and women's Experiences with Childbirth preparation. J Gend Cult Health, 160-7.
34. Veghari G, Rahamti R, Ebadpour M, et al (2016). Cesarean section and some socio-demographics related factors in the north of Iran: an epidemiologic study. Int J Adv Biotechnol Res, 7:229-34.
35. Rahman MM, Haider MR, Moinuddin M, et al (2018). Determinants of caesarean section in Bangladesh: Cross-sectional analysis of Bangladesh Demographic and Health Survey 2014 Data. PloS One, 13(9):e0202879.
36. Heffner LJ, Elkin E, Fretts RC (2003). Impact of labor induction, gestational age, and maternal age on cesarean delivery rates. Obstet Gynecol,102(2): 287-93.
37. Ecker JL, Chen KT, Cohen AP, et al (2001). Increased risk of cesarean delivery with advancing maternal age: indications and associated factors in nulliparous women.
Am J Obstet Gynecol, 185(4): 883-7.
38. Lin H-C, Xirasagar S (2005). Maternal age and the likelihood of a maternal request for cesarean delivery: a 5-year population-based study. Am J Obstet Gynecol, 192(3): 848-55.
39. Martel M, Wacholder S, Lippman A, et al (1987). Maternal age and primary cesarean section rates: a multivariate analysis. Am J Obstet Gynecol, 156(2): 305-8.
40. Rosenthal AN, Paterson-Brown S (1999). Is There an Incremental Rise in the Risk of Obstetric Intervention With Increasing Maternal Age? BJOG: An International Journal of Obstetrics & Gynaecology, 105(10): 1064-1069.
41. Huesch MD (2011). Association between type of health insurance and elective cesarean deliveries: New Jersey, 2004–2007. Am J Public Health, 101(11):e1-7.
42. Alimohammadian M, Shariat M, Mahmoodi M, Ramezanzadeh F (2007). Choice of delivery in Tehran and some related factors. Journal of Family and Reproductive Health. 1(2): 79-84.
2. Lumbiganon P, Laopaiboon M, Gülmezoglu AM , et al (2010). Method of delivery and pregnancy outcomes in Asia: the WHO global survey on maternal and perinatal health 2007-08. Lancet, 375(9713): 490-9.
3. Villar J, Valladares E, Wojdyla D, et al (2006). Caesarean delivery rates and pregnancy outcomes: the 2005 WHO global survey on maternal and perinatal health in Latin America. Lancet, 367(9525): 1819-29.
4. Laws PJ, Sullivan DE, Grayson N (2004). Australia's mothers and babies 2007: AIHW National Perinatal Statistics Unit Sydney, NSW, Australia.
5. Tranquilli AL, Giannubilo SR (2004). Cesarean delivery on maternal request in Italy. Int J Gynaecol Obstet, 84(2): 169-70.
6. Gibbons L, Belizán JM, Lauer JA, et al (2010). The global numbers and costs of additionally needed and unnecessary caesarean sections performed per year: overuse as a barrier to universal coverage. Bull World Health Organ, 30:1-31.
7. Rafati F, Rafati S, Madani A, et al (2014). Related factors to choose cesarean section among Jiroft pregnant women. Journal of Prrventive Medicine 1(1): 23-30.
8. Amu O, Rajendran S, Bolaji II (1998). Maternal choice alone should not determine method of delivery. BMJ, 463-465.
9. Alimohamadian M, Shariat M, Mahmoudi M, Ramazanzadeh F (2003). The influence of maternal request on the elective cesarean section rate in maternity hospitals in Tehran, Iran. Payesh, 2(2): 137-142.
10. Ecker JL (2004). Once a pregnancy, always a cesarean? Rationale and feasibility of a randomized controlled trial. Am J Obstet Gynecol, 190(2):314-8.
11. Mylonas I, Friese K (2015). Indications for and risks of elective cesarean sec-tion. Dtsch Arztebl Int, 112(29-30):489-495.
12. Villar J, Carroli G, Zavaleta N, et al (2007). Maternal and neonatal individual risks and benefits associated with caesarean delivery: multicentre prospective study. BMJ, 335(7628):1025.
13. Al‐Kadri H, Sabr Y, Al‐Saif S, et al (2003). Failed individual and sequential instrumental vaginal delivery: contributing risk factors and maternal–neonatal complications. Acta Obstet Gynecol Scand, 82(7):642-8.
14. Khooshideh M, Mirzarahimi T (2017). The Comparison of Maternal and Neonatal Outcomes of Normal Vaginal Delivery versus Unplanned Cesarean Section De-livery. J Ardabil Univ Med Sci,17(1): 122-132.
15. Bodner K, Wierrani F, Grünbrger W, Bodner-Adler B (2011). Influence of the mode of delivery on maternal and neonatal outcomes: a comparison between elective cesarean section and planned vaginal delivery in a low-risk obstetric population. Arch Gynecol Obstet, 283(6): 1193-8.
16. O’Neill SM, Kearney PM, Kenny LC, et al (2013). Caesarean delivery and subsequent pregnancy interval: a systematic review and meta-analysis. BMC Pregnancy Childbirth, 13: 165.
17. Declercq E, Barger M, Cabral HJ, et al (2007). Maternal outcomes associated with planned primary cesarean births compared with planned vaginal births. Obstet Gynecol, 109(3): 669-77.
18. Smith GC, Pell JP, Bobbie R (2003). Caesarean section and risk of unexplained stillbirth in subsequent pregnancy. Lancet, 362(9398): 1779-84.
19. Lydon-Rochelle M, Holt VL, Easterling TR, Martin DP (2001). First-birth cesarean and placental abruption or previa at second birth(1). Obstet Gynecol, 97: 765-9.
20. Azami-Aghdash S, Ghojazadeh M, Dehdilani N, Mohammadi M (2014). Prevalence and causes of cesarean section in Iran: systematic review and meta-analysis.
Iran J Public Health, 43(5) :545-555.
21. Pang SM, Leung DT, Leung T, et al (2007). Determinants of preference for elective caesarean section in Hong Kong Chinese pregnant women. Hong Kong Med J, 13(2): 100-5.
22. Fenwick J, Staff L, Gamble J, et al (2010). Why do women request caesarean section in a normal, healthy first pregnancy? Midwifery, 26(4): 394-400.
23. Fuglenes D, Aas E, Botten G, Øian P, Kristiansen IS (2011). Why do some pregnant women prefer cesarean? The influence of parity, delivery experiences, and fear. Am J Obstet Gynecol, 205(1):45.e1-9.
24. Schneider F, Winn H (2000). Cesarean section and vaginal birth after cesarean section. In: Clinical maternal. New York, Parthenon Press, 15-18.
25. Ronsmans C, Holtz S, Stanton C (2006). Socioeconomic differentials in caesarean rates in developing countries: a retrospective analysis. Lancet, 368(9546): 1516-23.
26. Mi J, Liu F (2014). Rate of caesarean section is alarming in China. Lancet, 383(9927): 1463-1464.
27. Hsu K-H, Liao P-J, Hwang C-J (2008). Factors affecting Taiwanese women's choice of cesarean section. Soc Sci Med, 66(1): 201-9.
28. Leone T, Padmadas SS, Matthews Z (2008). Community factors affecting rising caesarean section rates in developing countries: an analysis of six countries. Soc Sci Med, 67(8): 1236-46.
29. Steele F, Diamond I, Wang D (1996). The determinants of the duration of contraceptive use in China: A multilevel multinomial discrete-hazards mdeling approach. Demography, 33(1): 12-23.
30. Moghimbeigi A (2011). A score test for extra zeros in negative binomial mixed models. Journal of Statistical Computation and Simulation, 81(5): 635-44.
31. Moghimbeigi A, Eshraghian MR, Moham-mad K, McArdle B (2009). A score test for zero-inflation in multilevel count data. Computational Statistics & Data Analysis, 53(4): 1239-1248.
32. Cai W-W, Marks JS, Chen C, et al (1998). Increased cesarean section rates and emerging patterns of health insurance in Shanghai, China. Am J Public Health, 88(5): 777-80.
33. Lamaz B (1998). Socioeconomic status and women's Experiences with Childbirth preparation. J Gend Cult Health, 160-7.
34. Veghari G, Rahamti R, Ebadpour M, et al (2016). Cesarean section and some socio-demographics related factors in the north of Iran: an epidemiologic study. Int J Adv Biotechnol Res, 7:229-34.
35. Rahman MM, Haider MR, Moinuddin M, et al (2018). Determinants of caesarean section in Bangladesh: Cross-sectional analysis of Bangladesh Demographic and Health Survey 2014 Data. PloS One, 13(9):e0202879.
36. Heffner LJ, Elkin E, Fretts RC (2003). Impact of labor induction, gestational age, and maternal age on cesarean delivery rates. Obstet Gynecol,102(2): 287-93.
37. Ecker JL, Chen KT, Cohen AP, et al (2001). Increased risk of cesarean delivery with advancing maternal age: indications and associated factors in nulliparous women.
Am J Obstet Gynecol, 185(4): 883-7.
38. Lin H-C, Xirasagar S (2005). Maternal age and the likelihood of a maternal request for cesarean delivery: a 5-year population-based study. Am J Obstet Gynecol, 192(3): 848-55.
39. Martel M, Wacholder S, Lippman A, et al (1987). Maternal age and primary cesarean section rates: a multivariate analysis. Am J Obstet Gynecol, 156(2): 305-8.
40. Rosenthal AN, Paterson-Brown S (1999). Is There an Incremental Rise in the Risk of Obstetric Intervention With Increasing Maternal Age? BJOG: An International Journal of Obstetrics & Gynaecology, 105(10): 1064-1069.
41. Huesch MD (2011). Association between type of health insurance and elective cesarean deliveries: New Jersey, 2004–2007. Am J Public Health, 101(11):e1-7.
42. Alimohammadian M, Shariat M, Mahmoodi M, Ramezanzadeh F (2007). Choice of delivery in Tehran and some related factors. Journal of Family and Reproductive Health. 1(2): 79-84.
| Files | ||
| Issue | Vol 50 No 4 (2021) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v50i4.6008 | |
| Keywords | ||
| Cesarean delivery Vaginal delivery Multilevel models Zero-inflated | ||
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How to Cite
1.
Zandkarimi E, Moghimbeigi A, Mahjub H. Assessing the Factors Affecting Cesarean Section Selection in Ira-nian Women Using Multilevel Count Models with Excess Zeros. Iran J Public Health. 2021;50(4):816-824.
