Prevalence, indications, and preference of caesarean section deliveries among women attending primary health care units in Port-Said City, Egypt

BACKGROUND: With the changing perception of Caesarean Section (CS) from a lifesaving to a routine procedure, non-medically indicated CS is increasing. This study assessed the prevalence, indications, and preference for CS among women attending primary health care (PHC) units in Port Said Governorate, Egypt. METHODS: A cross-sectional study was conducted from December 2023 to February 2024 in six primary health care units across Port-Said Governorate, Egypt. Married women of childbearing age who had experienced at least one childbirth (primiparous and multiparous) were included. A total of 179 participants were recruited using multistage sampling, combining random selection of PHC units and consecutive sampling of eligible women. Data were collected using a validated structured questionnaire covering socio-demographics, obstetric history, last delivery experience, and preference for the next delivery. Statistical analysis was performed using SPSS v26, including univariate and multivariate logistic regression to identify factors associated with CS and delivery preference. RESULTS: A total of 179 women participated in the study. Of these, 68% had CS for their last delivery. The most frequently reported reasons for previous CS were fear of labor (56%), prolonged labor (18%), and long distance to the hospital (15.6%). Regarding future delivery preferences, (61.5%) of women expressed a preference for CS. The leading reasons cited were less pain (81.8% ), the belief that CS is safer for the baby (57.3%), and the knowledge of the time of delivery (32.2%). Multivariate logistic regression identified independent predictors for each outcome. Women with higher income [AOR 10.0, 95% CI 2.7-36.9, < 0.001] and those whose doctor suggested CS [AOR 19.2, 95% CI 5.5-67.1, p < 0.001] were more likely to have had a CS in their last delivery. In contrast, preference for CS in the next delivery was independently associated with higher husband education [AOR 12.1, 95% CI 1.2-124.3, p = 0.036] and a history of previous CS [AOR 14.7, 95% CI 6.2-34.6, p < 0.001]. CONCLUSION: Fear of labor and previous CS were the main drivers of past and preferred future CS deliveries, with non-medical factors outweighing medical indications. Findings highlight the need for educational interventions to support informed delivery choices.