Background & aim: Cesarean section (CS) is a life-saving intervention in specific obstetric situations, yet it has become one of the most frequently performed surgical procedures, globally. This study investigated socioeconomic, maternal, neonatal, and health system determinants influencing the choice of delivery mode in Tehran Province between March 2023 to March 2024.
Methods: The study included 400 mothers who had given birth during the study period, with participants selected using stratified sampling based on urban and rural population distribution. This study was conducted in healthcare facilities across Tehran Province. Data were collected using a researcher-developed questionnaire. The questionnaire included questions on participants’ demographic, socioeconomic, maternal, and obstetric characteristics, as well as their mode of delivery. The questionnaire was completed by eligible mothers after obtaining informed consent. Given the binary nature of the outcome (delivery mode), data were analyzed using Chi-square and Mann–Whitney U tests, followed by penalized binary logistic regression in Stata 17.
Results: The overall CS rate was 62%. Penalized logistic regression analysis showed that women aged >31 years had significantly higher odds of cesarean delivery (OR = 4.02; 95% CI: 1.49–10.87; P = 0.006). Maternal employment in the public sector was also associated with increased odds of CS (OR = 4.50; 95% CI: 1.66–12.22; P = 0.003), as was having supplementary health insurance (OR = 2.01; 95% CI: 1.10–3.68; P = 0.023). In contrast, a history of stillbirth (OR = 0.06; 95% CI: 0.01–0.48; P = 0.008), participation in prenatal birth-preparation classes (OR = 0.41; 95% CI: 0.24–0.69; P = 0.001), and delivering in public hospitals or at home compared to private hospitals (OR = 0.30; 95% CI: 0.16–0.56; P < 0.001) were associated with lower odds of cesarean delivery.
Conclusion: These findings highlight the multifactorial nature of maternal choice of delivery mode and underscore the importance of strengthening maternal education, improving access to supportive prenatal services, and developing evidence-based policies to promote appropriate delivery practices.