Prevalence and determinants of caesarean section in Jamaica.

Researchers analyzed data on 2395 hospital births which occurred to 2328 14-49 year old women between January 1984 and May 1989 living in 7 parishes of Jamaica to determine the prevalence and factors of cesarean section. The primary cesarean section rate for the 5.5-year period was 4.1% which is lower than the rates of some developing countries and of some developed countries such as the US. The repeat cesarean section rate was 1.3%. Cephalopelvic disproportion and/or prolonged labor (abnormal labor) accounted for 17.4% of all primary cesarean sections. Abnormal labor carried the greatest risk of primary cesarean section (logistic regression model beta=1.9). Other delivery complications which posed considerable risk of cesarean section included breech presentation (beta=1.68) maternal diabetes (beta=0.84) maternal hypertension (beta=0.47) large birth weight infant (beta=0.4) and low birth weight infant (beta=-0.15). These complications made up 22.3% 7.1% 7.4% and 5.3% of all primary cesarean sections respectively. Nonmedical determinants of primary cesarean section included >30-year old women (beta=1.04) 1-2 births (beta=-1.27) urban residence (beta=0.75) and delivering in a private hospital (beta=0.59). 5.3% of >30-year old mothers underwent a cesarean section compared with 3.8% of 3 did. Urban mothers were more likely to have a cesarean section than were rural mothers (5.4% vs. 3.3%). 7.6% of mothers delivering at a private hospital underwent a cesarean section compared with 3.9% of those delivering at a government hospital. Well-designed studies of infant mortality in Jamaica can determine whether the country can attain low levels of early infant mortality while keeping its current low rate of cesarean section.