Background & Aims: 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 delivery mode selection in Tehran Province between 2023 and 2024.
Methods: This population-based cross-sectional study included 400 women residing in Tehran Province, selected through stratified sampling. 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: Cesarean delivery was influenced by maternal age, maternal occupation, supplementary insurance coverage, and participation in prenatal classes, highlighting the need for targeted educational and policy interventions. These findings underscore the need for targeted educational initiatives and policy measures aimed at optimizing delivery mode decisions and reducing unnecessary CS.