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Open Access Research article

Influence of delivery characteristics and socioeconomic status on giving birth by caesarean section – a cross sectional study during 2000–2010 in Finland

Sari Räisänen12*, Mika Gissler34, Michael R Kramer1 and Seppo Heinonen25

Author Affiliations

1 Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, USA

2 Department of Obstetrics and Gynaecology, Kuopio University Hospital, P.O. Box 100, Kys, Kuopio, FI 70029, Finland

3 National Institute for Health and Welfare (THL), P.O. Box 30, Paciuksenkatu 21, Helsinki, FI 00271, Finland

4 Nordic School of Public Health, Gothenburg, Sweden

5 School of Medicine, University of Eastern Finland, P.O. Box 1627, Kuopio, FI 70211, Finland

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BMC Pregnancy and Childbirth 2014, 14:120  doi:10.1186/1471-2393-14-120

Published: 31 March 2014

Abstract

Background

Caesarean section (CS) rates especially without medical indication are rising worldwide. Most of indications for CS are relative and CS rates for various indications vary widely. There is an increasing tendency to perform CSs without medical indication on maternal request. Women with higher socioeconomic status (SES) are more likely to give birth by CS. We aimed to study whether giving birth by CS was associated with SES and other characteristics among singleton births during 2000–2010 in Finland with publicly funded health care.

Methods

Data were gathered from the Finnish Medical Birth Register. The likelihood of giving birth by CS according to CS type (planned and non-planned), parity (nulliparous vs. multiparous), socio-demographic factors, delivery characteristics and time periods (2000–2003, 2004–2007 and 2008–2010) was determined by using logistic regression analysis. SES was classified as upper white collar workers (highest SES), lower white collar workers, blue collar workers (lowest SES), others (all unclassifiable cases) and cases with missing information.

Results

In total, 19.8% (51,511 of 259,736) of the nulliparous women and 13.1% (47,271 of 360,727) of the multiparous women gave birth by CS. CS was associated with several delivery characteristics, such as placental abruption, placenta previa, birth weight and fear of childbirth, among both parity groups. After adjustment, the likelihood of giving birth by planned CS was reduced by 40% in nulliparous and 55% in multiparous women from 2000–2003 to 2008–2010, whereas the likelihood of non-planned CSs did not change. Giving birth by planned and non-planned CS was up to 9% higher in nulliparous women and up to 17% higher in multiparous women in the lowest SES groups compared to the highest SES group.

Conclusions

Giving birth by CS varied by clinical indications. Women with the lowest SES were more likely to give birth by CS, indicating that the known social disparity in pregnancy complications increases the need for operative deliveries in these women. Overall, the CS policy in Finland shows favoring a trial of labor over planned CS and reflects no inequity in healthcare services.

Keywords:
Birth; Caesarean section; Childbirth; Population register; Register; Socioeconomic status