ABSTRACT
BACKGROUND: The cesarean section (C-section) has higher risk compared to normal vaginal delivery (NVD). The aim of this population-based study was to evaluate the frequency of mothers' tendency toward the mode of delivery and the factors that can affect this inclination. MATERIALS AND METHODS: This cross-sectional study was conducted from August 2011 to June 2012 in Fars Province, Iran, and comprised mothers in their 20(th) to 30(th) weeks of pregnancy. A questionnaire was designed to include, sociodemographic information, maternal knowledge, main sources of knowledge, attitude of the mother, husband, parents, close friends, and gynecologist, regarding the route of delivery, convenience factors, and barriers to choosing NVD, and mother's preference for the route of delivery. RESULTS: Of 6921 participants, 2197 (31.7%) preferred C-section and 4308 (62.2%) favored NVD while 416 (6%) had no idea regarding the preferred route of delivery. Score of knowledge in 904 (13.1%) participants was zero, and 1261 women (18.2%) achieved an acceptable level of knowledge. Using binary logistic regression, positive history of previous abortion and/or infertility, higher education level of mother and husband, mother's unacceptable level of knowledge regarding complications of C-section, and mother's and husband's positive attitude toward C-section were determinant factors in choosing C-section as a preferred route of delivery. CONCLUSION: Appropriate measures should be taken to raise awareness and knowledge of mothers and all families about complications of the C-section. Establishment of clinics for painless NVD and assuring mothers of benefits and lower complications of NVD can reduce the tendency for C-sections.
ABSTRACT
BACKGROUND: The high rate of maternal mortality (MM) remains a challenge, especially in developing countries. In 2000, the World Health Organization (WHO) targeted a 75% reduction by the end of 2015. In this survey, we determine trends in MM rates and associated factors in Fars Province, southwestern Iran. METHODS: All MM in Fars Province from March 2003 to March 2010 were considered in this cross-sectional study. Data were recorded for demographic characteristics, autopsy findings, medical and obstetric histories. The data were then analyzed with a z-test to identify differences in the rate of MM during the study period. RESULTS: The mean MM rate was 22.18 per 100 000 live births (95% CI, 17.55-26.8) during the seven year study period, and was highest (32.3/100 000) in the first year. Most deaths (71.3%) occurred in the postpartum period, and the lowest proportion occurred during delivery (5%). High-risk mothers accounted for 79.2% of maternal deaths. Among the mothers who died, 62% received satisfactory prenatal care, and at least two years elapsed between successive pregnancies in 78%. Hemorrhage was the main cause of death (35.6%) and the least frequent cause was H1N1 virus infection (2%). CONCLUSION: This study provides evidence of serious deficiencies in postpartum care that need urgent action. Priority should be given to vaginal bleeding and high-risk status mothers.
