BACKGROUND: Although the percentage of cesarean sections (CS) in Czechia is below the average of that of other developed countries (23.6%), it still exceeds WHO recommendations (15%). The first aim of the study is to examine the association between a CS birth and the main health factors and sociodemographic characteristics involved, while the second aim is to examine recent trends in the CS rate in Czechia. METHODS: Anonymized data on all mothers in Czechia for 2018 taken from the National Register of Expectant Mothers was employed. The risk of cesarean delivery for the observed factors was tested via the construction of a binary logistic regression model that allowed for adjustments for all the other covariates in the model. RESULTS: Despite all the covariates being found to be statistically significant, it was determined that health factors represented a higher risk of a CS than sociodemographic characteristics. A previous CS was found to increase the risk of its recurrence by 33 times (OR = 32.96, 95% CI 30.95-35.11, p<0.001). The breech position increased the risk of CS by 31 times (OR = 31.03, 95% CI 28.14-34.29, p<0.001). A multiple pregnancy increased the odds of CS six-fold and the use of ART 1.8-fold. Mothers who suffered from diabetes before pregnancy were found to be twice as likely to give birth via CS (OR = 2.14, 95% CI 1.76-2.60, p<0.001), while mothers with gestational diabetes had just 23% higher odds of a CS birth (OR = 1.23, 95% CI 1.16-1.31, p<0.001). Mothers who suffered from hypertension gave birth via CS twice as often as did mothers without such complications (OR = 2.01, 95% CI 1.86-2.21, p<0.001). CONCLUSIONS: The increasing age of mothers, a significant risk factor for a CS, was found to be independent of other health factors. Accordingly, delayed childbearing is thought to be associated with the increase in the CS rate in Czechia. However, since other factors come into play, further research is needed to assess whether the recent slight decline in the CS rate is not merely a temporal trend.

Department of Demography and Geodemography Faculty of Science Charles University Prague Czechia

Department of Gynecology and Obstetrics 2nd Faculty of Medicine Charles University and Motol University Hospital Prague Czechia

Zobrazit více v PubMed

Ye J, Zhang J, Mikolajczyk R, Torloni MR, Gülmezoglu AM, Betran AP. Association between rates of caesarean section and maternal and neonatal mortality in the 21st century: a worldwide population-based ecological study with longitudinal data. BJOG. 2016 doi: 10.1111/1471-0528.13592. PubMed DOI PMC

Betran AP, Torloni MR, Zhang JJ, Gülmezoglu AM. WHO Working Group on Caesarean Section. WHO Statement on Caesarean Section Rates. BJOG. 2016;123(5):667–70. doi: 10.1111/1471-0528.13526. PubMed DOI PMC

Boerma T, Ronsmans C, Melesse DY, Barros AJD, Barros FC, Juan L, Moller AB, Say L, Hosseinpoor AR, Yi M, de Lyra RabelloNeto D, Temmerman M. Global epidemiology of use of and disparities in caesarean sections. Lancet. 2018;392(10155):1341–1348. doi: 10.1016/S0140-6736(18)31928-7. PubMed DOI

OECD. Health at a Glance 2019. Chapter 9. Figure 9.16. Caesarean section rates, 2017 (or nearest year). OECD Health Statistics. 2019. 10.1787/888934017918.

Laurita Longo V, Odjidja EN, Beia TK, Neri M, Kielmann K, Gittardi I, Di Rosa AI, Boldrini M, Melis GB, Scambia G, Lanzone A. "An unnecessary cut?" multilevel health systems analysis of drivers of caesarean sections rates in Italy: a systematic review. BMC Pregnancy Childbirth. 2020 doi: 10.1186/s12884-020-03462-1. PubMed DOI PMC

Czech Statistical Office (CZSO).Population movement in the Czech Republic 1920–2020: analytical indicators. 2021. https://www.czso.cz/csu/czso/obyvatelstvo_hu. Accessed 10 Jul 2021.

National Registry of Mothers at Childbirth (NRMC). Anonymised individual data from the National Registry of Mothers at Childbirth on women who gave birth in 2016–2018 in the Czech Republic. 2018.

IHIS CR. Mother and newborn 1999–2015. Institute of Health Information and Statistics of the Czech Republic. 2001–2017. https://www.uzis.cz/index-en.php?pg=publications--library&id=249. Accessed 15 Apr 2021.

Cr IHIS. Mother and newborn 1997. Prague: Institute of Health Information and Statistics of the Czech Republic; 2000.

Cr IHIS. Mother and newborn 1998. Prague: Institute of Health Information and Statistics of the Czech Republic; 2000.

Cr IHIS. Report on mothers at childbirth in 1994–1996. Prague: Institute of Health Information and Statistics of the Czech Republic; 2000.

Rydahl E, Declercq E, Juhl M, Maimburg RD. Cesarean section on a rise—Does advanced maternal age explain the increase? A population register-based study. PLoS ONE. 2019;14(1):e0210655. doi: 10.1371/journal.pone.0210655. PubMed DOI PMC

Šťastná A, Kocourková J, Šídlo L. Reprodukční stárnutí v Česku v kontextu Evropy. [Reproduction ageing in Czechia in the European context] Čas Lék čes. 2019;158:126–32. PubMed

Kocourková J, Šťastná A. The realization of fertility intentions in the context of childbearing postponement: comparison of transitional and post-transitional populations. J Biosoc Sci. 2021 doi: 10.1017/S002193202000005X. PubMed DOI

Šťastná A, Slabá J, Kocourková J. Plánování, časování a důvody odkladu narození prvního dítěte v České republice. [The planning, timing, and factors behind the postponement of first births in the Czech Republic] Demografie. 2017;59(3):207–23.

Kurkin R, Šprocha B, Šídlo L, Kocourková J. Fertility factors in Czechia according to the results of the 2011 census. AUC-Geographica. 2018;53(2):137–148. doi: 10.14712/23361980.2018.14. DOI

Šťastná A, Slabá J, Kocourková J. Druhé dítě – důvody neplánovaného odkladu a časování jeho narození [Reasons for the Unplanned Postponement and Timing of the Birth of a Second Child] Demografie. 2019;61(2):77–92.

Kocourková J, Fait T. Can increased use of ART retrieve the Czech Republic from the low fertility trap? Neuro Endocrinol Lett. 2009;30(6):739–748. PubMed

Kocourková J, Burcin B, Kučera T. Demographic relevancy of increased use of assisted reproduction in European countries. Reprod Health. 2014 doi: 10.1186/1742-4755-11-37. PubMed DOI PMC

Kenny LC, Lavender T, McNamee R, O'Neill SM, Mills T, Khashan AS. Advanced maternal age and adverse pregnancy outcome: evidence from a large contemporary cohort. PLoS ONE. 2013 doi: 10.1371/journal.pone.0056583. PubMed DOI PMC

Fall CH, Sachdev HS, Osmond C, Restrepo-Mendez MC, Victora C, Martorell R, Stein AD, Sinha S, Tandon N, Adair L, Bas I, Norris S, Richter LM. COHORTS investigators. Association between maternal age at childbirth and child and adult outcomes in the offspring: a prospective study in five low-income and middle-income countries (COHORTS collaboration) Lancet Glob Health. 2015;3(7):e366–77. doi: 10.1016/S2214-109X(15)00038-8. PubMed DOI PMC

Timofeev J, Reddy UM, Huang CC, Driggers RW, Landy HJ, Laughon SK. Obstetric complications, neonatal morbidity, and indications for cesarean delivery by maternal age. Obstet Gynecol. 2013 doi: 10.1097/AOG.0000000000000017. PubMed DOI PMC

Sauer MV. Reproduction at an advanced maternal age and maternal health. Fertil Steril. 2015 doi: 10.1016/j.fertnstert.2015.03.004. PubMed DOI

WHO. Born too soon: the global action report on preterm birth. Geneva: World Health Organization; 2012.

Spong CY. Defining "term" pregnancy: recommendations from the Defining "Term" Pregnancy Workgroup. JAMA. 2013 doi: 10.1001/jama.2013.6235. PubMed DOI

Gill SV, May-Benson TA, Teasdale A, Munsell EG. Birth and developmental correlates of birth weight in a sample of children with potential sensory processing disorder. BMC Pediatr. 2013 doi: 10.1186/1471-2431-13-29. PubMed DOI PMC

von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med. 2007;147(8):573–7. doi: 10.7326/0003-4819-147-8-200710160-00010. PubMed DOI

Robson M, Hartigan L, Murphy M. Methods of achieving and maintaining an appropriate caesarean section rate. Best Pract Res Clin Obstet Gynaecol. 2013 doi: 10.1016/j.bpobgyn.2012.09.004. PubMed DOI

WHO  WHO Statement on caesarean section rates. Reproductive Health Matters. 2015;23(45):18. PubMed

Betrán AP, Temmerman M, Kingdon C, Mohiddin A, Opiyo N, Torloni MR, Zhang J, Musana O, Wanyonyi SZ, Gülmezoglu AM, Downe S. Interventions to reduce unnecessary caesarean sections in healthy women and babies. Lancet. 2018 doi: 10.1016/S0140-6736(18)31927-5. PubMed DOI

Liu S, Liston RM, Joseph KS, Heaman M, Sauve R, Kramer MS. Maternal Health Study Group of the Canadian Perinatal Surveillance System. Maternal mortality and severe morbidity associated with low-risk planned cesarean delivery versus planned vaginal delivery at term. CMAJ. 2007;176(4):455–60. doi: 10.1503/cmaj.060870. PubMed DOI PMC

Negrini R, da Silva Ferreira RD, Guimarães DZ. Value-based care in obstetrics: comparison between vaginal birth and caesarean section. BMC Pregnancy Childbirth. 2021 doi: 10.1186/s12884-021-03798-2. PubMed DOI PMC

Wen SW, Rusen ID, Walker M, Liston R, Kramer MS, Baskett T, Heaman M, Liu S. Maternal Health Study Group, Canadian Perinatal Surveillance System. Comparison of maternal mortality and morbidity between trial of labor and elective cesarean section among women with previous cesarean delivery. Am J Obstet Gynecol. 2004;191(4):1263–9. doi: 10.1016/j.ajog.2004.03.022. PubMed DOI

Schifrin BS, Cohen WR. The effect of malpractice claims on the use of caesarean section. Best Pract Res Clin Obstet Gynaecol. 2013;27(2):269–83. doi: 10.1016/j.bpobgyn.2012.10.004. PubMed DOI

Hua Z, El Oualja F. Indicators for mode of delivery in pregnant women with uteruses scarred by prior caesarean section: a retrospective study of 679 pregnant women. BMC Pregnancy Childbirth. 2019 doi: 10.1186/s12884-019-2604-0. PubMed DOI PMC

Roberts CL, Algert CS, Ford JB, et al. Pathways to a rising caesarean section rate: a population-based cohort study. BMJ Open. 2012;2(5):e001725. doi: 10.1136/bmjopen-2012-001. PubMed DOI PMC

Roberts Christine L, Algert Charles S, Todd Angela L, Morris JM. Reducing caesarean section rates – No easy task. Aust N Z J Obstet Gynaecol. 2013;53:310–313. doi: 10.1111/ajo.12065. PubMed DOI

Hannah ME, Hannah WJ, Hewson SA, Hodnett ED, Saigal S, Willan AR. Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial. Term Breech Trial Collaborative Group. Lancet. 2000 doi: 10.1016/s0140-6736(00)02840-3. PubMed DOI

Toijonen A, Heinonen S, Gissler M, Macharey G. Risk factors for adverse outcomes in vaginal preterm breech labor. Arch Gynecol Obstet. 2021 doi: 10.1007/s00404-020-05731-y. PubMed DOI PMC

Schoen C, Rosen T. Maternal and perinatal risks for women over 44–a review. Maturitas. 2009;64(2):109–113. doi: 10.1016/j.maturitas.2009.08.012. PubMed DOI

Kort DH, Gosselin J, Choi JM, Thornton MH, Cleary-Goldman J, Sauer MV. Pregnancy after age 50: defining risks for mother and child. Am J Perinatol. 2012;29(4):245–250. doi: 10.1055/s-0031-1285101. PubMed DOI

Čechurová D, Andělová K. Doporučený postup péče o diabetes mellitus v těhotenství 2014. [Recommendation for the diabetes care in pregnancy]. DMEV. 2014;17(2):55–60. http://www.diab.cz/dokumenty/standard_tehotenstvi.pdf.

Nybo Andersen AM, Wohlfahrt J, Christens P, Olsen J, Melbye M. Maternal age and fetal loss: population based register linkage study. BMJ. 2000 doi: 10.1136/bmj.320.7251.1708. PubMed DOI PMC

Vlachová T, Kocourková J, Fait T. Vyšší věk matky – rizikový faktor pro nízkou porodní váhu. [Advance maternal age – risk factor for low birhtweight] Česká gynekologie. 2018;83(5):337–40. PubMed

Kocourková J, Šídlo L, Šťastná A, Fait T. Vliv věku matky na porodní hmotnost novorozenců. [Impact of the mother’s age at childbirth on the birth weight of new-born children] Čas Lék čes. 2019;158:118–25. PubMed

Goldenberg RL, Culhane JF, Iams JD, Romero R. Epidemiology and causes of preterm birth. Lancet. 2008 doi: 10.1016/S0140-6736(08)60074-4. PubMed DOI PMC

Kong L, Nilsson IAK, Gissler M, Lavebratt C. Associations of Maternal Diabetes and Body Mass Index With Offspring Birth Weight and Prematurity. JAMA Pediatr. 2019 doi: 10.1001/jamapediatrics.2018.5541. PubMed DOI PMC

Šídlo L, Šťastná A, Kocourková J, Fait T. Vliv věku matky na zdravotní stav novorozenců v Česku. [Impact of the mother's age at childbirth on the health of new-born children in Czechia] Demografie. 2019;61(3):155–74.

Schneider H. Schonende Geburtsleitung bei sehr frühen Frühgeburten [Gentle obstetrical management for very early preterm deliveries] Gynakol Geburtshilfliche Rundsch. 2004;44(1):10–18. doi: 10.1159/000074312. PubMed DOI

Mackin ST, Nelson SM, Kerssens JJ, Wood R, Wild S, Colhoun HM, Leese GP, Philip S, Lindsay RS. SDRN Epidemiology Group. Diabetes and pregnancy: national trends over a 15 year period. Diabetologia. 2018;61(5):1081–1088. PubMed PMC

Agrawal A, Wenger NK. Hypertension During Pregnancy. Curr Hypertens Rep. 2020 doi: 10.1007/s11906-020-01070-0. PubMed DOI

Khalil A, Syngelaki A, Maiz N, Zinevich Y, Nicolaides KH. Maternal age and adverse pregnancy outcome: a cohort study. Ultrasound Obstet Gynecol. 2013;42(6):634–643. doi: 10.1002/uog.12494. PubMed DOI

Sobotka T, Šťastná A, Zeman K, Hamplová D, Kantorová V. Czech Republic: A Rapid Transformation of fertility and family behaviour after the collapse of state Socialism. Demographic Res. 2008;19:403–54. doi: 10.4054/DemRes.2008.19.14. DOI

Polesná H, Kocourková J. Je druhý demografický přechod stále relevantní koncept pro evropské státy? [Is the second demographic transition the relevant concept for European countries?] Geografie. 2016 doi: 10.37040/geografie2016121030390. DOI

Lodge-Tulloch NA, Elias FTS, Pudwell J, Gaudet L, Walker M, Smith GN, Velez MP. Caesarean section in pregnancies conceived by assisted reproductive technology: a systematic review and meta-analysis. BMC Pregnancy Childbirth. 2021;21(1):244. doi: 10.1186/s12884-021-03711-x. PubMed DOI PMC

Liu H, Umberson DJ. The times they are a changin’: marital status and health differentials from 1972 to 2003. J Health Soc Behav. 2008;49(3):239–53. doi: 10.1177/002214650804900301. PubMed DOI PMC

Tollånes MC, Thompson JM, Daltveit AK, Irgens LM. Cesarean section and maternal education; secular trends in Norway, 1967–2004. Acta Obstet Gynecol Scand. 2007 doi: 10.1080/00016340701417422. PubMed DOI

Villar J, Carroli G, Zavaleta N, et al. Maternal and neonatal individual risks and benefits associated with caesarean delivery: multicentre prospective study. BMJ. 2007 doi: 10.1136/bmj.39363.706956.55. PubMed DOI PMC

Opiyo N, Kingdon C, Oladapo OT, Souza JP, Vogel JP, Bonet M, Bucagu M, Portela A, McConville F, Downe S, Gülmezoglu AM, Betrán AP. Non-clinical interventions to reduce unnecessary caesarean sections: WHO recommendations. Bull World Health Organ. 2020;98:66–68. doi: 10.2471/BLT.19.236729. PubMed DOI PMC

Francese M, Piacenza M, Romanelli M, Turati G. Understandign inapropriateness in health spending role of regional policies and institutions in Caesarean deliveries. Reg Sci Urban Econ. 2014;2014(49):262–277. doi: 10.1016/j.regsciurbeco.2014.02.006. DOI

Mancuso A, De Vivo A, Fanara G, Settineri S, Triolo O, Giacobbe A. Women's preference on mode of delivery in Southern Italy. Acta Obstet Gynecol Scand. 2006 doi: 10.1080/00016340600645255. PubMed DOI

Panda S, Daly D, Begley C, Karlström A, Larsson B, Bäck L, Hildingsson I. Factors influencing decision-making for caesarean section in Sweden – a qualitative study. BMC Pregnancy Childbirth. 2018 doi: 10.1186/s12884-018-2007-7. PubMed DOI PMC

Sandall J, Tribe RM, Avery L, Mola G, Visser GH, Homer CS, Gibbons D, Kelly NM, Kennedy HP, Kidanto H, Taylor P, Temmerman M. Short-term and long-term effects of caesarean section on the health of women and children. Lancet. 2018 doi: 10.1016/S0140-6736(18)31930-5. PubMed DOI

Salas Garcia MC, Yee AL, Gilbert JA, Dsouza M. Dysbiosis in Children Born by Caesarean Section. Ann Nutr Metab. 2018 doi: 10.1159/000492168. PubMed DOI

Kuhle S, Tong OS, Woolcott CG. Association between caesarean section and childhood obesity: a systematic review and meta-analysis. Obes Rev. 2015 doi: 10.1111/obr.12267. PubMed DOI

Chen I, Opiyo N, Tavender E, Mortazhejri S, Rader T, Petkovic J, Yogasingam S, Taljaard M, Agarwal S, Laopaiboon M, Wasiak J, Khunpradit S, Lumbiganon P, Gruen RL, Betran AP. Non-clinical interventions for reducing unnecessary caesarean section. Cochrane Database Syst Rev. 2018 doi: 10.1002/14651858.CD005528.pub3. PubMed DOI PMC

Cepicky P. Postupy lege artis I. Moderní gynekologie a porodnictví. [Procedures lege artis I. Modern gynaecology and obstetrics.] 2004;13(4):Suppl C. ISBN 80-87070-00-3.

López-López AI, Sanz-Valero J, Gómez-Pérez L, Pastor-Valero M. Pelvic floor: vaginal or caesarean delivery? A review of systematic reviews. Int Urogynecol J. 2021 doi: 10.1007/s00192-020-04550-8. PubMed DOI

The association between preterm births and assisted reproductive technologies

Does advanced maternal age explain the longer hospitalisation of mothers after childbirth?

Does Advanced Maternal Age Comprise an Independent Risk Factor for Caesarean Section? A Population-Wide Study