Choice of mode of delivery and associated factors among pregnant women with one previous scar at two public hospitals in Kampala

Abstract

Background; There is unnecessarily increasing rate of cesarean sections in Uganda despite a success rate of 60-80% for women delivering vaginally after a cesarean section. This has led to increased health costs and associated complications. We investigated the choice of mode of delivery and associated factors among pregnant women with one previous scar with non-recurring indications for cesarean section. Methods; The was a cross-sectional analytical study that was conducted among pregnant women with one previous scar attending antenatal care at two public hospitals in Uganda. A mother was eligible for inclusion into the study if she had no recurrent indication for caesarian section. The study was conducted from September to October 2022. A total of 169 pregnant women were consecutively recruited into the study. Data was collected using a purposively formulated a questionnaire and analyzed in STATA 17. We used descriptive statistics to understand the characteristics of mother and a modified Poisson regression model was used to obtain factors associated with the mode of delivery Results; The mean age of participants was 28(4.88) years. More than 2/3r ds (137) 81% of the participant’s preferred a trial of labor. Mothers who preferred to have more than four children were more likely to opt for a trial of labor (aPR=0.27, CI; 0.15-1.01, p =0.009). Mothers who feared medical expenses were more likely to choose a trial of labor (aPR=1.2, CI; 1.01-1.49, p=0.03), mothers who perceived that a cesarean section affects body image (aPR=3.06, CI 1.39-6.75, p=0.03), and being women who were employed (aPR=0.84, CI; 0.74-0.96, p=0.01) were more likely to prefer a cesarean section. Conclusion and recommendationsTrial of labor remains the most preferred choice of delivery. A desire to have more children in the future, a perception that a cesarean section distorts body image, and a fear of medical expenses increased the likelihood of having a vaginal birth. Being employed increased the likelihood of preferring a cesarean section. A trial of labor should be adapted for all women with non-recurrent indications for cesarean section. Strengthening the potential of women to make informed choices, and training them on the risks and benefits of CS in order for them to make informed decisions.