Non-medical factors on choice of delivery (CS/NVD) in hospitals of Tehran University of Medical Sciences


Background: Kind of delivery affect many aspects of individuals, families and health systems situations. The aim of this study was to identify the Role of non-medical factors on choice of delivery (CS/NVD) in hospitals affiliated to Tehran University of Medical Sciences. Materials and Method: This cross-sectional study was performed to identify the factors involved in the choice of delivery (CS/NVD) among women attending hospitals affiliated to Tehran University of Medical Sciences. Data was derived from the medical records of women who gave birth in the hospitals. Results: A significant statistical relationship was found between factors such as age of mother, level of education, occupational status, type of previous delivery, person supervising the pregnancy and dissatisfaction about delivery were more frequent in women who underwent CS than those who gave birth by NVD. Conclusion: The highly increasing rise in the rate of unnecessary CS during throughout the world, and its adverse effect on maternal and child health, the financial burden imposed on families and health systems, has highlighted the importance of studies to identify the non-medical factors that affect decision-making concerning type of delivery as well as to determine the appropriate medical indications of CS.

Share and Cite:

Ostovar, R. , Rashidi, B. , Haghallahi, F. , Fararoei, M. , Rasouli, M. and Naeimi, E. (2013) Non-medical factors on choice of delivery (CS/NVD) in hospitals of Tehran University of Medical Sciences. Open Journal of Obstetrics and Gynecology, 3, 67-73. doi: 10.4236/ojog.2013.31015.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Kabir, A.A., Steinmann, W.C., Myers, L., Khan, M.M., Herrera, E.A., Yu, S. and Jooma, N. (2004) Unnecessary cesarean delivery in Louisiana: An analysis of birth certificate data. American Journal of Obstetrics and Gynecology, 190, 10-19.
[2] Lin, H.-C. and Xirasagar. S. (2005) Maternal age and the likelihood of a maternal request for cesarean delivery: A 5-year population-based study. American Journal of Obstetrics and Gynecology, 192, 848-855. doi:10.1016/j.ajog.2004.09.133
[3] Gomes, U.A., Silva, A.A., Bettiol, H. and Barbieri, M.A. (1999) Risk factors for the increasing caesarean section rate in Southeast Brazil: A comparison of two birth cohorts, 1978-1979 and 1994. International Journal of Epidemiology, 28, 687-694. doi:10.1093/ije/28.4.687
[4] Evans, L. (1995) Italy has Europe’s highest caesarean section rate. British Medical Journal, 310, 487. doi:10.1136/bmj.310.6978.487
[5] World Health Organization (1985) Appropriate technology for birth. Lancet, 2, 436-437.
[6] Shearer, E.L. (1993) Cesarean section: Medical benefits and costs. Social Science & Medicine, 37, 1223-1231. doi:10.1016/0277-9536(93)90334-Z
[7] Goer, H. (2001) The case against elective cesarean section. The Journal of Perinatal & Neonatal Nursing, 15, 23-38.
[8] Herng, C.L., Tzong, C.S., Chao, H.T. and Senyeong, K. (2004) Association between maternal age and the likely-hood of a cesarean section: A population-based multivariate logistic regression analysis. Acta Obstetricia et Gynecologica Scandinavica, 83, 1178-1183.
[9] Lavender, T., Hofmeyr, G.J., Neilson, J.P., Kingdon, C. and Gyte, G.M.L. (2006) Caesarean section for non-medical reasons at term. The Cochrane Library, The Cochrane Collaboration Volume (4).
[10] Gould, J.B., Davey, B. and Stafford, R.S. (1989) Socio-economic differences in rates of cesarean section. The New England Journal of Medicine, 321, 233-239. doi:10.1056/NEJM198907273210406
[11] Newton, E.R. and Higgins, C.S. (1989) Factors associated with hospitalspecific cesarean birth rates. Journal of Reproductive Medicine, 34, 407-411.
[12] Burns, L.R., Geller, S.E. and Wholey, D.R. (1995) The effect of physician factors on the cesarean section decision. Medical Care, 33, 365-382. doi:10.1097/00005650-199504000-00004
[13] Goer, H. (2001) The case against elective cesarean section. Journal of Perinatal and Neonatal Nursing, 15, 23-38.
[14] Lowdon, G. and Derrick, D. (2002) Caesarean section or vaginal birth—What difference does it make? AIMS Quarterly Journal, 14, 1-4.
[15] McAleese, S. (2000) Caesarean section for maternal choice? Midwifery Matters, 84, 12-14.
[16] Gamble, J. and Creedy, D.K. (2000) Women’s request for cesarean section: A critique of the literature. Birth, 27, 256-263. doi:10.1046/j.1523-536x.2000.00256.x
[17] Freeman, R.K., Cohen, A.W., Depp III, R., Frigoletto Jr., F.D., Hankins, G.D.V., Lieberman, E., et al. (2000) Evaluation of cesarean delivery. The American College of Obstetricians and Gynecologists, Washington DC.
[18] Nicollier, F.A., Vader, J.P., Froehlich, F., Gonvers, J.J. and Burnand, B. (2003) Development of appropriateness criteria for colonoscopy. International Journal of Health Care, 15, 15-22.
[19] Paul, G.S., James, P.K., Steven, J., Lucian, L.L., Caren, J.K. and Park, R.E. (1998) The reproducibility of a method to identify the overuse and under use of medical procedures. The New England Journal of Medicine, 338, 1888-1895. doi:10.1056/NEJM199806253382607
[20] Phelps, E.C. (1993) The methodologic foundations of studies of the appropriateness of medical care. The New England Journal of Medicine, 1329, 1241-1245. doi:10.1056/NEJM199310213291707
[21] The National Collaborating Centre for Women’s and Childrens Health (2004) Caesarean section clinical guideline. RCOG Press, London.
[22] The Iranian Ministry of Health (2005) The fertility health assessment program, family health section.
[23] Liu, X. and Miles, A. (1999) Evaluating payment mechanisms: How can we measure unnecessary care? Health Policy and Planning, 14, 409-413. doi:10.1093/heapol/14.4.409
[24] Ostvar, R., Rashidian, A., Pourreza, A., Rashidi, B.H., Hantoushzadeh, S. and Eftekhar, A.H. (2010) Developing criteria for Cesarean section using the RAND appropriateness method 2010. BMC Pregnancy and Childbirth, 52, 1-8.
[25] Peipert, J.F. and Bracken, M.B. (1993) Maternal age: An independent risk factor for cesarean delivery. Obstetrics & Gynecology, 81, 200-205.
[26] Martel, M., Wacholder, S., Lippman, A., Brohan, J. and Hamilton, E. (1987) Maternal age and primary cesarean section rates: A multivariate analysis. American Journal of Obstetrics & Gynecology, 156, 305-308.
[27] Ezra, Y., McParland, P. and Farine, D. (1995) High delivery intervention rates in nulliparous women over age 35. European Journal of Obstetrics & Gynecology and Reproductive Biology, 62, 203-207. doi:10.1016/0301-2115(95)02201-H
[28] Paterson-Brown, S., Amu, O., Rajendran, S. and Bolaji, I.I. (1998) Should doctors perform an elective caesarean section on request? British Medical Journal, 317, 462-467.
[29] Sultan, A.H. and Stanton, S.L. (1996) Preserving the pelvic floor and perineum during childbirth-elective caesarean section? British Journal of Obstetrics and Gynaecology, 103, 731-734. doi:10.1111/j.1471-0528.1996.tb09864.x
[30] Feldman, G.B. and Freiman, J.A. (1985) Prophylactic cesarean sectio at term? The New England Journal of Medicine, 312, 1265-1267. doi:10.1056/NEJM198505093121926
[31] FIGO Committee for the Ethical Aspects of Human Reproduction and Women’s Health (1999) Ethical aspects regarding cesarean delivery for non-medical reasons. International Journal of Gynecology & Obstetrics, 64, 317-322. doi:10.1016/S0020-7292(98)00266-5
[32] Wagner, M. (2000) Choosing caesarean section. Lancet, 356, 1677-1680. doi:10.1016/S0140-6736(00)03169-X
[33] Ryding, E.L. (1993) Investigation of 33 women who demanded a cesarean section for personal reasons. Acta Obstetricia et Gynecologica Scandinavica, 72, 280-285. doi:10.3109/00016349309068038
[34] Ventura, S.J., Martin, J.A., Curtin, S.C. and Mathews, T.J. (1999) Birth: Final data for 1997. National Vital Statistics Reports, 47, 1-83.
[35] Notzon, F.C., Cnattingius, S., Bergsjo, P., Cole, S., Taffel, S., Irgens, L., et al. (1994) Cesarean section delivery in the 1980s: International comparison by indication. American Journal of Obstetrics & Gynecology, 170, 495-504.
[36] Rosen, M.G., Dickinson, J.C. and Westhoff, C.L. (1991) Vaginal birth after cesarean: A meta-analysis of morbidity and mortality. Obstetrics & Gynecology, 77, 465-470.
[37] Flamm, B.L. (1995) Vaginal birth after cesarean section. In: Flamm, B.L. and Quilligan, E.J., Eds., Cesarean section: Guidelines for appropriate utilization. Springer-Verlag, New York, 51-64.
[38] Pridjian, G. (1992) Labor after prior cesarean section. Clinical Obstetrics and Gynecology, 35, 445-456. doi:10.1097/00003081-199209000-00004
[39] Carpenter, M.W., Soule, D., Yates, W.T. and Meeker, C.I. (1987) Practice environment is associated with obstetric decision making regarding abnormal labor. Obstetrics & Gynecology, 70, 657-662.
[40] DeMott, R.K. and Sandmire, H.F. (1992) The Green Bay cesarean section study. II. The physician factor as a determinant of cesarean birth rates for failed labor. American Journal of Obstetrics & Gynecology, 166, 1799-1806, Discussion 1806-1810.
[41] Hodnett, E. (1996) Nursing support of the laboring woman. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 25, 257-264. doi:10.1111/j.1552-6909.1996.tb02434.x
[42] Hueston, W.J. (1995) Site-to-site variation in the factors affecting cesarean section rates. Archives of Family Medicine, 4, 346-351.
[43] Lieberman, E. (1997) Predictors of cesarean delivery. Current Problems in Obstetrics, Gynecology, and Fertility, 20, 98-131.
[44] McCloskey, L., Petitti, D.B. and Hobel, C.J. (1992) Variations in the use of cesarean delivery for dystocia: Lessons about the source of care. Medical Care, 30, 126-135.
[45] Savage, W. and Francome, C. (1993) British caesarean section rates: Have we reached a plateau? British Journal of Obstetrics and Gynaecology, 100, 493-496.
[46] Rock, S.M. (1988) Malpractice premiums and primary cesarean section rates in New York and Illinois. Public Health Reports, 103, 459-463.
[47] Localio, A.R., Lawthers, A.G., Bengston, J.M., Hebert, L.E., Weaver, S.L., Brennan, T.A., et al. (1993) Relationship between malpractice claims and cesarean delivery. Journal of the American Medical Association, 269, 366-373.
[48] Griffin, L.P., Heland, K.V., Esser, L. and Jones, S. (1998) Overview of the 1996 professional liability survey. American Congress of Obstetricians and Gynecologists Clinical Review, 3, 1-2, 13-14.

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.