Early effects of the normal birth action plan on mode of birth, maternal preference, and cesarean indications in a private hospital setting in Türkiye

Background: Cesarean section (CS) rates have risen globally to unprecedented levels, becoming a major public health concern. Türkiye has one of the highest CS rates among OECD countries, reaching approximately 57%, far above World Health Organization recommendations. In response, the Ministry of Health introduced the Normal Birth Action Plan (NBAP) in October 2024 to promote vaginal birth (VB) and reduce medically unnecessary CS. However, the real-world impact of NBAP in private hospitals-where maternal preference, fear of childbirth, institutional dynamics, and medico-legal concerns strongly influence mode of birth-remains unclear. Objective: To evaluate the early effects of NBAP on mode of birth distribution in a private hospital and to examine CS indications, maternal preference, and the role of NBAP-related counseling. Methods: < 0.05 considered statistically significant. Results: < 0.001). Similar trends were observed across age groups (18-30 vs. ≥31 years). Monthly analyses showed a gradual increase in VB following NBAP implementation. Total births decreased by approximately 37% during the post-NBAP period, suggesting additional contextual or demographic influences. Conclusion: In this private hospital cohort, the post-NBAP period was temporally associated with a reduction in cesarean births and an increase in vaginal births, along with a decrease in CS attributed to maternal request or fear of VB. However, given the retrospective design and concurrent changes in birth volume, causality cannot be inferred. Multicentre studies with longer follow-up are required to clarify these associations.