Obstetric Profiles and Cesarean Section Rates Among Women Who Gave Birth in Malatya: A Cross-Sectional Survey Study Using Snowball Sampling

Abstract

Aim: This study aims to examine the obstetric profiles and modes of delivery of women who have given birth in Malatya and to evaluate the relationship between risk status and cesarean section (C-section) rates.

Material and Methods: The study was designed as a cross-sectional descriptive study and conducted among women who had given birth in Malatya. The sample was obtained using a snowball sampling method, and data were collected via an online survey created with Google Forms. Data were analyzed using SPSS version 25.0. Descriptive statistics, independent samples t-test and Pearson’s chi-square test were applied. In addition, binary logistic regression and multivariable logistic regression analyses were performed; results were reported as odds ratios (OR) with 95% confidence intervals.

Results: In this study, the overall cesarean section rate was 68.3%. Among women without risk factors, the cesarean rate was 52.2%, whereas it increased to 71.8% among those with at least one risk factor. Among women whose previous delivery was by cesarean, 97.8% had a repeat cesarean for the current birth. Among primiparous women, 76.3% delivered by cesarean. Multivariable logistic regression analysis identified maternal age (OR=1.081; p=0.005) and previous cesarean delivery (OR=9.079; p=0.001) as independent predictors of cesarean birth.

Conclusion: Cesarean section rates were high among women who had given birth in Malatya, exceeding both national and international reference values. Previous cesarean history emerged as the strongest predictor of cesarean birth. These findings emphasize the importance of developing strategies to reduce primary cesarean rates, promoting safe vaginal birth after cesarean, and enhancing the educational content of prenatal programs to improve maternal health outcomes.

Keywords

• Pregnancy
• maternal healht services
• risk factors
• cesarean section
• delivery
• obstetric

References

1. Taşkın L. Gebelikte anneyi değerlendirme. In: Taşkın L, editor. Doğum ve kadın sağlığı hemşireliği. 16th ed. Akademisyen Kitapevi; 2020. p. 113-31.
2. Davis EP, Narayan AJ. Pregnancy as a period of risk, adaptation, and resilience for mothers and infants. Dev Psychopathol. 2020;32(5):1625-39. doi:10.1017/S0954579420001121.
3. Aygar H, Metintaş S. Bir kalkınma göstergesi olarak anne ölümleri. Eskişehir Türk Dünyası Uygul Araşt Merk Halk Sağlığı Derg. 2018;3(3):63-70. izlik no:JA87FU98RB.
4. World Health Organization (WHO). Maternal mortality [Internet]. Geneva; 2025 [cited 2025 Sep 24]. Available from: https://www.who.int/news-room/fact-sheets/detail/maternal-mortality
5. World Health Organization (WHO). Maternal health [Internet]. Geneva; 2023 [cited 2025 Sep 24]. Available from: https://www.who.int/health-topics/maternal-health#tab=tab_1
6. Holness N. High-risk pregnancy. Nurs Clin North Am. 2018;53(2):241–51. doi:10.1016/j.cnur.2018.01.010.
7. Williamson SP, Moffitt RL, Broadbent J, Neumann DL, Hamblin PS. Coping, wellbeing, and psychopathology during high-risk pregnancy: a systematic review. Midwifery. 2023;116:103556. doi:10.1016/j.midw.2022.103556.
8. Osterman MJK. Changes in primary and repeat cesarean delivery: United States 2016-2021. CDC Stacks; 2022 [cited 2025 Sep 08]. Available from: https://stacks.cdc.gov/view/cdc/117432

9. World Health Organization (WHO). Statement on caesarean section rates [Internet]. Geneva; 2021 [cited 2025 Sep 08]. Available from: https://www.who.int/news-room/questions-and-answers/item/who-statement-on-caesarean-section-rates-frequently-asked-questions
10. Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, et al. Relationship between cesarean delivery rate and maternal and neonatal mortality. JAMA. 2015;314(21):2263-70. doi:10.1001/jama.2015.15553.
11. Sandall J, Tribe RM, Avery L, Mola G, Visser GH, Homer CS, et al. Short-term and long-term effects of caesarean section on the health of women and children. Lancet. 2018;392(10155):1349-57. doi:10.1016/S0140-6736(18)31930-5.
12. Mersha A, Shibiru S. Cesarean section: short- and long-term consequences [Internet]. In: Androutsopoulos G. editor. Advances in caesarean section - techniques, complications, and future considerations. InTechOpen; 2024 [cited 2025 Sep 08]. doi:10.5772/intechopen.114382.
13. Ulgu MM, Birinci S, Ensari TA, Gözükara MG. Cesarean section rates in Turkey 2018-2023: Overview of national data by using Robson ten group classification system. Turk J Obstet Gynecol. 2023;20(3):191-8. doi:10.4274/tjod.galenos.2023.68235.
14. TÜİK Veri Portalı. Haber bülteni: doğum istatistikleri, 2024 [Internet]. Ankara: T.C. İçişleri Bakanlığı; 2025 [cited 2025 Sep 08]. Available from: https://data.tuik.gov.tr/Bulten/Index?p=Dogum-Istatistikleri-2024-54196
15. Eurostat. (2023). Demography of Europe – 2023 edition [Internet]. European Commission; 2025 [cited 2025 Sep 08], Available from: https://ec.europa.eu/eurostat/web/interactive-publications/demography-2023
16. Yikar SK, Nazik E. Effects of prenatal education on complaints during pregnancy and on quality of life. Patient Educ Couns. 2019;102(1):119-25. doi:10.1016/j.pec.2018.08.023.
17. Athinaidou AM, Vounatsou E, Pappa I, Harizopoulou VC, Sarantaki A. Influence of antenatal education on birth outcomes: a systematic review focusing on primiparous women. Cureus. 2024;16(7):e64508. doi:10.7759/cureus.64508.
18. Mohammed HH, Hamed AAA El, Afefy NAEF, Sherif NA, Ibrahim SM. The effectiveness of nurse-led antenatal education on maternal self-efficacy: an evidence-based approach. BMC Nurs. 2025;24(1):895. doi:10.1186/s12912-025-03471-5.
19. T.C. Sağlık Bakanlığı. Gebe bilgilendirme sınıfı eğitim kitabı [Internet]. Ankara: Türkiye Halk Sağlığı Kurumu; 2014 [cited 2025 Sep 24]. Available from: https://hsgm.saglik.gov.tr/depo/birimler/kadin-ve-ureme-sagligi-db/Rehberler/gebe-bilgilendirme-egitim-kitabi.pdf
20. T.C. Sağlık Bakanlığı. Gebe okulları ile doğuma yönelik hizmetlerin usul ve esasları hakkında yönetmelik. Sayı 32751 [Internet]. Ankara: T.C. Resmî Gazete [Official Gazette of the Republic of Türkiye]. 2024 Dec 13 [cited 2025 Sep 24]. Available from: https://www.resmigazete.gov.tr/eskiler/2024/12/20241213-2.htm
21. Antoine C, Young BK. Cesarean section one hundred years 1920-2020: the good, the bad and the ugly. J Perinat Med. 2020;49(1):5-16. doi:10.1515/jpm-2020-0305.
22. Cross SN, Greenberg JT, Pettker CM, Raab CA, Illuzzi JL. Indications contributing to the decreasing cesarean delivery rate at an academic tertiary center. Am J Obstet Gynecol MFM. 2019;1(2):165-72. doi:10.1016/j.ajogmf.2019.05.002.
23. Keag OE, Norman JE, Stock SJ. Long-term risks and benefits associated with cesarean delivery for mother, baby, and subsequent pregnancies: Systematic review and meta-analysis. PLoS Med. 2018;15(1):e1002494. doi:10.1371/journal.pmed.1002494.
24. Macones GA, Peipert J, Nelson DB, Odibo A, Stevens EJ, Stamilio DM, et al. Maternal complications with vaginal birth after cesarean delivery: a multicenter study. Am J Obstet Gynecol. 2005;193(5):1656-62. doi:10.1016/j.ajog.2005.04.002.
25. Silver RM, Landon MB, Rouse DJ, Leveno KJ, Spong CY, Thom EA, et al. Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol. 2006;107(6):1226-32. doi:10.1097/01.AOG.0000219750.79480.84.
26. World Health Organization (WHO). Caesarean section rates continue to rise, amid growing inequalities in access. Departmental update [Internet]. Geneva; 2021 [cited 2025 Sep 29]. Available from: https://www.who.int/news/item/16-06-2021-caesarean-section-rates-continue-to-rise-amid-growing-inequalities-in-access
27. Guise JM, Denman MA, Emeis C, Marshall N, Walker M, Fu R, et al. Vaginal birth after cesarean: new insights on maternal and neonatal outcomes. Obstet Gynecol. 2010;115(6):1267-78. doi:10.1097/AOG.0b013e3181df925f.
28. Guise JM, Eden K, Emeis C, Denman MA, Marshall N, Fu R, et al. Vaginal birth after cesarean: new insights. In: Evidence Report/Technology Assessment No. 191 [Internet]. Rockville, MD: Agency for Healthcare Research and Quality; 2010 [cited 2025 Sep 29]. p. 143-53. Available from: https://www.ahrq.gov/downloads/pub/evidence/pdf/vbacup/vbacup.pdf
29. Chien P. Global rising rates of caesarean sections. BJOG. 2021;128(5):781-2. doi:10.1111/1471-0528.16666.