Patterns and stakeholder-perceived drivers of Caesarean section practices: Evidence from a multicenter study in a lower-middle-income country.

This mixed-method study aimed to generate local evidence on the patterns of cases of C-Sections and to qualitatively explore perceptions of stakeholders regarding the drivers of current C-Sections practices and WHO-recommended, evidence-based interventions for reducing unnecessary C-Sections in Pakistan. The study population included 605 women who underwent C-Sections in either public, private or semi-private healthcare facilities. A prior history of C-Section was the most common reason for subsequent C-Sections, with Group 5 being (multiparous women with a previous C-section, carrying a singleton fetus in cephalic presentation at term) the greatest contributor to the overall C-Section rate. Qualitative data revealed that a majority of women do not prefer C-Sections mainly due to the prolonged recovery time associated with it; however, pain associated with vaginal birth may be a compelling factor for women to opt for C-Sections. Improved birth preparedness and counselling on pain management may be appropriate non-clinical interventions to reduce unnecessary C-Sections in Pakistan. There is an expressed need to implement WHO-recommended guidelines on non-clinical interventions to reduce unnecessary C-Sections in Pakistan.