Study On The Factors Related To Mode Of Delivery Among Reproductive Women In Hunan Province

Objective:To find out the constitution of the delivery mode and the prevalence of cesarean section in the reproductive population in Hunan Province so that to explore the influencing factors of affecting the mode of delivery and the level of cesarean section and probe cities aggregation of cesarean section rate.Materials and methods:The data were from the fertility research project of Hunan Medical Insurance Bureau. We selected from 3,000 cases randomly in the database. The remaining 2567 cases were used of our analysis excluding the 453 cases without the delivery ending. We divided the delivery mode into natural childbirth, vaginal delivery and cesarean section for Ordinal regression analysis, and into cesarean section and non-cesarean section for non-conditional Logistic regression and two-level model. We used Excel to establish a database and SAS9.13, SPSS13.0 and MLwiN to make statistical analysis. Chi-square/Fisher exact tests were used to compare categorical variables. Two-level models analysis was used to explore districts agrregation and independent significant factors.Results:The proportion of cesarean section among the reproductive population was 62.1%and the proportions of 14 cities were different with cities aggregation. The average age of reproductive population was 27.22 years and the mean gestational age was 38.9 weeks. Univariate analysis showed that the factors affecting the constitution of the delivery mode were cities, hospital categories and levels, nationalities, education levels, occupation, child bearing insurance, social factor, gestational weeks, dysticia, pregnancy complications, multiple pregnancy, great children, fetal distress, cephalopelvic disproportion and umbilical cord around the neck. Ordinal regression analysis showed the independent factors affecting the delivery mode were hospital levels, social factors, dysticia, pregnancy complications, great children, fetal distress and umbilical cord around the neck. The most influential factor was social factors (OR=40.21), followed by fetal distress (OR=37.08), the minimal impact was the 2-A hospitals (OR=1.77). Non-conditional Logistic regression analysis showed the independent factors affecting the caesarean section rate were hospital levels, nationalities, social factors, gestational weeks, dysticia, pregnancy complications, great children, fetal distress and umbilical cord around the neck. Social factor still was the most important factor (OR=36.88), followed by fetal distress (OR=36.90), the minimal impact was nationalities (OR=1.42). Two-level model showed social factors was the greatest strength to promote the caesarean section rates (OR=15.17) in the demographic characteristics, followed by child bearing insurance (OR=12.81), the minimal impact was age (OR= 3.07); farmers and others and the higher education level population were lean to practice non-cesarean section. Meanwhile, cephalopelvic disproportion was the greatest strength of bio-medical factors (OR=41.02), followed by fetal distress, and pregnancy complications (OR were 5.25 and 5.16 respectively). The minimal was gestational weeks (OR= 1.83) and multipara was lean to practice non-cesarean section (OR= 0.79). Social factors had been the most important factors in leading the development of the cesarean section rate by the former analysis of three methods.Conclusions:At present, the proportions of cesarean section of the 14 cities were rather high, as well as existing the cities aggregation. The mode of delivery leant to cesarean section and the reasons were associate not only with abnormal biomedical factors, but also with some demographic factors, especially social factors,. It is necessary to take measures to reduce the unnecessary CS in Hunan Province.