Do psychological factors predict caesarean delivery in Australia? A cohort study

Abstract

Background: The proportion of babies delivered by Cesarean Section (CS) in Australia has almost doubled over the last 25 years. Factors known to contribute to CS such as higher maternal age, mothers being overweight or obese, or having had a previous CS do not completely account for the increased rate and it is clear that other influences exist. Our study used nationally-representative data from the Longitudinal Study of Australian Children (LSAC) to identify risk factors associated with CS, with a view to identifying previously unidentified influences.

Methods: Data were from the birth cohort of LSAC, a long-term prospective study of approximately 5,000 children that includes richly-detailed data regarding maternal health and exposures during pregnancy. Logistic regression was used to examine the contribution of a wide range of pregnancy, birth and social factors to CS. Results: 28% of 4,862 mothers were delivered by CS. The nal adjusted analyses revealed that use of diabetes medication (OR=3.1, 95% CI=1.7-5.5, p<0.001) and maternal mental health problems during pregnancy (OR=1.3, CI=1.1-1.6, p=0.003) were associated with increased odds of CS. Young maternal age (OR=0.6, CI=0.5-0.7, p<0.001), having two or more children (OR=0.7, CI=0.6-0.9, p<0.001), and fathers having an unskilled occupation (OR=0.7, CI=0.6-1.0, p=0.036) were associated with reduced odds of CS.

Conclusion: Our findings raise the prospect that screening and intervention programs for maternal mental health problems, and attention to diabetic control in pregnancy, might be beneficial in reducing CS rates and should be studied in appropriately-constructed prospective trials.