Once therapeutic turns into elective: a cross-sectional analysis of cesarean section trends in İstanbul’s private hospitals
Abstract
Objective: Türkiye has one of the highest cesarean section (CS) rates among OECD countries, with private hospitals
performing the majority of CSs. This study aims to examine trends in mode of delivery and associated factors in two private
hospitals in İstanbul between 2015 and 2020.
Methods: In this registry-based cross-sectional study, data from 11,885 births were analyzed. Hospital 1 operated with a
Social Security Institution (SGK) contract, while hospital 2 served only with private financing. Data included delivery type,
antenatal visits, maternal age and health insurance. Statistical analyses included chi-square, independent samples t-test,
Mann-Whitney U test, Kruskal-Wallis, and Pearson correlation tests (p<0.05).
Results: Overall, 73.7% of deliveries were by CS. The rate declined from 78.9% in 2015 to 69.7% in 2020. CS rates were
higher in hospital 1 (77.9%) than in hospital 2. Only 15.5% of CSs were medically indicated. CS was significantly associated
with higher maternal age (32.8 vs. 31.7 years; p<0.001). Women who delivered vaginally attended more antenatal visits
(10.6 vs. 9.9; p=0.001). The number of antenatal visits declined sharply in 2020 (9.4 vs. 10.2 in 2019).
Conclusion: Despite a modest decline over time, CS rates remained high in both private hospitals studied, particularly
in the one contracted with SGK. The findings suggest that demographic, institutional, and healthcare utilization factors
influence CS practices. Further research is needed to address the low rate of medically indicated CS and inform strategies
to promote appropriate use.
Keywords
Maternal health, Cesarean section, Prenatal care, Türkiye
Ethical Statement
This research protocol has been
approved by Acıbadem University Medical Research
Ethics Commission on June 26th, 2020 (decree no:
ATADEK-2020/13). Permission to use the registry
data was obtained from the hospital administrations.
Thanks
We are grateful to our colleagues, Professors Hannan
Abdulrahim and Livia Celine Wick, for their diligent
review and valuable, constructive feedback.
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