caesarean delivery in south italy women without choice. a cross sectional survey剖腹产手术在南意大利妇女没有选择。.pdfVIP

Caesarean Delivery in South Italy: Women without Choice. A Cross Sectional Survey Pamela Barbadoro, Carlos Chiatti, Marcello Mario D’Errico, Francesco Di Stanislao, Emilia Prospero* ` Department of Biomedical Sciences, Universita Politecnica delle Marche, Ancona, Italy Abstract Background: In spite of the World Health Organization’s recommendations to maintain caesarean delivery (CD) between 5% and 15% of total births, the rates of CD continue to rise in countries with routine access to medical services. As in Italy CD rate reached 38% in 2008, the highest at EU level, we evaluated socioeconomic and clinical correlates of ‘‘elective’’ and ‘‘non programmed’’ CD in the Country. We performed a stratified analysis in order to verify whether the effect of such correlates differed among women with an ‘‘a priori’’ preference for natural and caesarean delivery respectively. Methods and Findings: We analyzed cross-sectional data from the Italian National Statistics Institute (ISTAT) survey on health condition. Socio-demographic variables, information on maternal care services use and health conditions during pregnancy, as well as maternal preferences on delivery, were available for a representative sample of 2,474 primiparous women. After an initial bivariate analysis, we used logistic regressions to evaluate factors associated to the study outcomes. Overall CD accounted for 35.5% of the total births in our sample (CI 33.6–37.4%); moreover, 30.7% (CI 28.6–32.6%) of women preferring natural delivery actually delivered with a CD. Elective CD rate is higher among women over 35 years (22.9%, CI 18.8–27.4%), and those living in the South (26.2%, CI 23.0–29.6%). The multivariate analysis showed that, even adjusting for several confounders, women in the South, receiving care in the private sector had