How Much Do Mothers Know? Evaluating Awareness of Medical Justifications for First Cesarean Deliveries: A Cross-sectional Study
DOI:
https://doi.org/10.54133/ajms.v10i1.2481Keywords:
Cesarean section, First-time delivery , Iraq, Maternal knowledge , Neonatal outcomes , Obstetric indicationsAbstract
Background: The rising rate of cesarean deliveries has generated concern about whether all procedures are medically justified. Limited data exist on how well first-time mothers understand the indications for their cesarean section in Iraq. Objective: To assess maternal knowledge of the medical reasons for the first cesarean delivery and its relationship with sociodemographic, obstetric, and neonatal characteristics. Methods: A cross-sectional study was conducted from October to December 2023 among 158 Iraqi women who underwent their first cesarean delivery. Data were collected using a structured, self-administered online questionnaire that assessed demographic, obstetric, and knowledge-related factors. Results: Less than half of the mothers (48.1%) demonstrated good knowledge of the reason for their cesarean section, whereas 23.4% showed poor awareness. Knowledge level was significantly associated with residency (p=0.024), history of vaginal birth (p=0.001), place of delivery (p=0.001), type of cesarean section (p=0.001), and hypertension during pregnancy (p=0.025). Mothers from rural areas, those delivering in public hospitals, and those undergoing emergency procedures had the highest proportions of poor knowledge. Poor awareness was also linked with adverse neonatal outcomes, including low birth weight (p=0.036), preterm birth (p=0.003), and neonatal distress (p=0.001). Conclusions: A considerable proportion of first-time Iraqi mothers lack adequate understanding of the medical indications for their cesarean delivery. Educational interventions and improved patient–provider communication, especially in rural areas and public hospitals, are essential to promote informed decision-making and better maternal–neonatal outcomes.
Downloads
References
Betrán AP, Ye J, Moller AB, Zhang J, Gülmezoglu AM, Torloni MR. The increasing trend in cesarean section rates: global, regional and national estimates: 1990–2014. PLoS One. 2016;11(2):e0148343. doi: 10.1371/journal.pone.0148343. DOI: https://doi.org/10.1371/journal.pone.0148343
Boerma T, Ronsmans C, Melesse DY, Barros AJD, Barros FC, Juan L, et al. Global epidemiology of use of and disparities in caesarean sections. Lancet. 2018;392(10155):1341–1348. doi: 10.1016/S0140-6736(18)31928-7. DOI: https://doi.org/10.1016/S0140-6736(18)31928-7
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.
;15(1):e1002494. doi: 10.1371/journal.pmed.1002494. DOI: https://doi.org/10.1371/journal.pmed.1002494
World Health Organization. WHO statement on caesarean section rates. Geneva: WHO; 2015.
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– 2270. doi: 10.1001/jama.2015.15553. DOI: https://doi.org/10.1001/jama.2015.15553
Betrán AP, Torloni MR, Zhang JJ, Gülmezoglu AM. WHO Working Group on Caesarean Section. WHO statement on caesarean section rates. BJOG. 2016;123(5):667–670. doi: 10.1111/14710528.13526. DOI: https://doi.org/10.1111/1471-0528.13526
Al-Kazaz F, Al-Hakeim H, Al-Rawi Z. Trends and determinants of cesarean section deliveries in Iraq: a hospital-based study. Iraqi J Med Sci. 2020;18(2):125–134.
Lumbiganon P, Laopaiboon M, Gülmezoglu AM, Souza JP, Taneepanichskul S, Ruyan P, et al. Method of delivery and pregnancy outcomes in Asia: the WHO global survey on maternal and perinatal health 2007–08. Lancet. 2010;375(9713):490–499. doi: 10.1016/S0140-6736(09)61870-5. DOI: https://doi.org/10.1016/S0140-6736(09)61870-5
Redshaw M, Martin CR, Savage-McGlynn E, Harrison S. Women's experiences of maternity care in England: preliminary development of a standard measure. BMC Pregnancy Childbirth. 2019;19(1):167. doi: 10.1186/s12884-019-2284-9. DOI: https://doi.org/10.1186/s12884-019-2284-9
Potter JE, Berquó E, Perpétuo IHO, Leal OF, Hopkins K, Souza MR, et al. Unwanted caesarean sections among public and private patients in Brazil: prospective study. BMJ. 2001;323(7322):1155–1158. doi: 10.1136/bmj.323.7322.1155. DOI: https://doi.org/10.1136/bmj.323.7322.1155
Stjernholm YV, Petersson K, Eneroth E. Changed indications for cesarean sections. Acta Obstet Gynecol Scand. 2010;89(1):49–53. doi: 10.3109/00016340903418777. DOI: https://doi.org/10.3109/00016340903418777
Panda S, Begley C, Daly D. Clinicians’ views of factors influencing decision-making for caesarean section: a systematic review and metasynthesis of qualitative, quantitative, and mixed methods studies. PLoS One. 2018;13(7):e0200941. doi: 10.1371/journal.pone.0200941. DOI: https://doi.org/10.1371/journal.pone.0200941
Maharlouei N, Moalaee M, Ajdari S, Zarei M, Lankarani KB. Caesarean delivery in south-western Iran: trends and determinants in a community-based survey. Med Princ Pract. 2013;22(2):184– 188. doi: 10.1159/000341764. DOI: https://doi.org/10.1159/000341762
Hellerstein S, Feldman S, Duan T. China’s 50% caesarean delivery rate: is it too high? BJOG. 2015;122(2):160–164. doi: 10.1111/1471-0528.12971. DOI: https://doi.org/10.1111/1471-0528.12971
Long Q, Kingdon C, Yang F, Renecle MD, Jahanfar S, Bohren MA, et al. Prevalence of and reasons for women’s, family members’, and health professionals’ preferences for cesarean section in China: A mixed-methods systematic review. PLoS Med. 2018;15(10):e1002672. doi: 10.1371/journal.pmed.1002672. DOI: https://doi.org/10.1371/journal.pmed.1002672
Bayrampour H, Heaman M. Advanced maternal age and the risk of cesarean birth: a systematic review. Birth. 2010;37(3):219-226. doi: 10.1111/j.1523-536X.2010.00409.x.
Zhang J, Troendle J, Reddy UM, Laughon SK, Branch DW, Burkman R, et al. Contemporary cesarean delivery practice in the United States. Am J Obstet Gynecol. 2010;203(4):326.e1-10. doi: 10.1016/j.ajog.2010.07.010. DOI: https://doi.org/10.1016/j.ajog.2010.06.058
Lin HC, Sheen TC, Tang CH, Kao S. Association between maternal age and the likelihood of a cesarean section: a population-based multivariate logistic regression analysis. Acta Obstet Gynecol Scand. 2004;83(12):1178-1183. doi: 10.1111/j.0001-6349.2004.00506.x. DOI: https://doi.org/10.1111/j.0001-6349.2004.00506.x
Kozhimannil KB, Hardeman RR, Henning-Smith C, Attanasio LB, Blauer-Peterson C, O’Brien M. Employment during pregnancy and obstetric intervention. Womens Health Issues. 2014;24(5):469476. doi: 10.1016/j.whi.2014.05.005. DOI: https://doi.org/10.1016/j.whi.2014.06.010
Béhague DP, Victora CG, Barros FC. Consumer demand for caesarean sections in Brazil: informed decision making, patient choice, or social inequality? BMJ. 2002;324:942-945. doi: 10.1136/bmj.324.7343.942. DOI: https://doi.org/10.1136/bmj.324.7343.942
Cavallaro FL, Cresswell JA, França GV, Victora CG, Barros AJ, Ronsmans C. Trends in caesarean delivery by country and wealth quintile: cross-sectional surveys in southern Asia and sub-Saharan Africa. Bull World Health Organ. 2013;91(12):914-922D. doi: 10.2471/BLT.13.117598. DOI: https://doi.org/10.2471/BLT.13.117598
Khanal V, Adhikari M, Karkee R, Gavidia T. Rural–urban differences in institutional delivery in Nepal: evidence from a multilevel analysis. Reprod Health. 2016;13:17. doi: 10.1186/s12978-0160139-2. DOI: https://doi.org/10.1186/s12978-016-0128-x
Iliyasu Z, Abubakar IS, Galadanci HS, Aliyu MH. Birth preparedness, complication readiness and fathers’ participation in maternity care in a northern Nigerian community. Afr J Reprod Health. 2010;14(1):21–32. PMID: 20695136.
Osei E, Anash JC, Osei A, Appiah EO. Awareness and perception of caesarean section among antenatal attendants in Ghana. Int J Reprod Contracept Obstet Gynecol. 2016;5(10):3434–3439. doi: 10.18203/2320-1770.ijrcog20163460. DOI: https://doi.org/10.18203/2320-1770.ijrcog20163460
Balcı O, Mahmutoğlu S, Karataylı R, Yılmaz E. Knowledge and attitudes of Turkish women toward cesarean section. J Obstet Gynaecol Res. 2017;43(7):1152–1158. doi: 10.1111/jog.13324. DOI: https://doi.org/10.1111/jog.13324
Vieira GO, Fernandes LG, de Oliveira NF, Silva LR, Vieira TO. Factors associated with cesarean delivery in public and private hospitals in northeastern Brazil: a cross-sectional study. BMC Pregnancy Childbirth. 2015;15:132. doi: 10.1186/s12884-015-0602-8. DOI: https://doi.org/10.1186/s12884-015-0570-8
Najmi RS, Rehan N. Prevalence and determinants of cesarean section in a teaching hospital in Pakistan. J Obstet Gynaecol. 2000;20(5):479–483. doi: 10.1080/01443610043495. DOI: https://doi.org/10.1080/014436100434640
Chaillet N, Dubé E, Dugas M, Francoeur D, Dubois J, Gagnon S, et al. Barriers and facilitators to implementing guidelines to reduce cesarean rates in Quebec. Bull World Health Organ. 2007;85(10):791–797. doi: 10.2471/BLT.06.039289. DOI: https://doi.org/10.2471/BLT.06.039289
Chalmers B, Kaczorowski J, Darling E, Heaman M, Fell D, O’Brien B, et al. Caesarean and vaginal birth in Canadian women: a comparison of experiences. Birth. 2012;39(2):109–118. doi: 10.1111/j.1523-536X.2012.00535.x. DOI: https://doi.org/10.1111/j.1523-536X.2012.00535.x
Abdel-Aleem H, Amin AF, Shokry M, Radwan RA. Therapeutic amnioinfusion for intrapartum fetal distress using a pediatric feeding tube. Int J Gynaecol Obstet. 2005;90(2):94–98. doi: 10.1016/j.ijgo.2005.04.023. DOI: https://doi.org/10.1016/j.ijgo.2005.03.027
Bayrampour H, Heaman M. Advanced maternal age and the risk of cesarean birth: a systematic review. Birth. 2010;37(3):219–226. doi: 10.1111/j.1523-536X.2010.00409.x. DOI: https://doi.org/10.1111/j.1523-536X.2010.00409.x
Aminu M, Utz B, Halim A, van den Broek N. Reasons for performing caesarean section in public hospitals in rural Bangladesh. BMC Pregnancy Childbirth. 2014;14:130. doi: 10.1186/1471-239314-130. DOI: https://doi.org/10.1186/1471-2393-14-130
Bedford J, Gandhi M, Admassu M, Girma A. “A normal delivery takes place at home”: a qualitative study of the location of childbirth in rural Ethiopia. Matern Child Health J. 2013;17(2):230–239. doi: 10.1007/s10995-012-0965-3. DOI: https://doi.org/10.1007/s10995-012-0965-3
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Al-Rafidain Journal of Medical Sciences ( ISSN 2789-3219 )

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Published by Al-Rafidain University College. This is an open access journal issued under the CC BY-NC-SA 4.0 license (https://creativecommons.org/licenses/by-nc-sa/4.0/).



