Maternal Health Outcomes and Complications from Multiple Caesarean Sections: An Analysis of Prevalence and Long-Term Risks
-
Abstract
The research examines the prevalence, risk, and decision-making determinants of multiple Caesarean sections among women in Maharashtra, India. Increased global Caesarean section rates have evoked concerns regarding their long-term maternal health effects, especially for multiple procedures. The research seeks to evaluate the prevalence of multiple Caesarean sections, examine complications such as uterine rupture and placental abnormality, and analyze awareness and decision-making determinants affecting repeat procedures. Using a mixed-methods design, the research draws on a standardized questionnaire administered to 41 women who had C-sections, using convenience sampling. Statistical inference using MS Excel and SPSS involves descriptive statistics, ANOVA, and regression models for the determination of demographic and healthcare-related determinants. Results indicate substantial differences in the prevalence of multiple C-sections among demographic groups, with younger women aged between 18 and 30 years having more procedures on average. Urban participants had higher reported access to healthcare compared to rural participants. Still, no statistically significant variations were found across age groups in ANOVA analysis. The research emphasizes the importance of specific interventions to mitigate inequalities in the access of healthcare and to reinforce maternal health management practices for women with multiple Caesarean sections. It recommends enhancing the awareness of women regarding risks related to repeat Caesarean procedures as well as promoting evidence-based obstetric practices.
Downloads
Metrics
References
Caesarean section epidemic: Tackling the rise of unnecessary cuts. (2019). *European Journal of Midwifery*, 3(March), 6.
Kirkinen, P. (1988). Multiple caesarean sections: outcomes and complications. BJOG: An International Journal of Obstetrics & Gynaecology, 95(8), 778-782.
Gupta, J. K., Smith, G. C. S., & Chodankar, R. R. (2015). Birth after previous caesarean birth. Green-top guideline, 45.
Silver, R. M., Landon, M. B., Rouse, D. J., Leveno, K. J., Spong, C. Y., Thom, E. A., ... & National Institute of Child Health and Human Development Maternal–Fetal Medicine Units Network. (2006). Maternal morbidity is associated with multiple repeat cesarean deliveries. Obstetrics & Gynecology, 107(6), 1226-1232.
Makoha, F. W., Felimban, H. M., Fathuddien, M. A., Roomi, F., & Ghabra, T. (2004). Multiple cesarean section morbidity. International Journal of Gynecology & Obstetrics, 87(3), 227-232.
Poma, P. A. (2000). Rupture of a cesarean-scared uterus: a community hospital experience. Journal of the National Medical Association, 92(6), 295.
Rashid, M., & Rashid, R. S. (2004). Higher order repeats caesarean sections: how safe are five or more? BJOG: An International Journal of Obstetrics & Gynaecology, 111(10), 1090-1094.
Sandall, J., Tribe, R. M., Avery, L., Mola, G., Visser, G. H., Homer, C. S., et al. (2018). Short-term and long-term effects of caesarean section on the health of women and children. *The Lancet*, 392(10155), 1349–1357. https://doi.org/10.1016/S0140-6736(18)31930-5
Hobbs, A. J., Mannion, C. A., McDonald, S. W., & Tough, S. C. (2016). The impact of caesarean section on breastfeeding initiation, duration and difficulties in the first four months postpartum. *BMC Pregnancy and Childbirth*, 16(90). https://doi.org/10.1186/s12884-016-0876-1
Rashid, M., & Rashid, R. S. (2004). Higher order repeats caesarean sections: how safe are five or more? BJOG: An International Journal of Obstetrics & Gynaecology, 111(10), 1090-1094.
Kaplanoglu, M., Bulbul, M., Kaplanoglu, D., & Bakacak, S. M. (2015). Effect of multiple repeat cesarean sections on maternal morbidity: Data from southeast Turkey. *Medical Science Monitor*, 21, 1447–1453.
Mohan, N. V., Shirisha, P., Vaidyanathan, G., & Banerjee, A. (2023). Variations in the prevalence of caesarean section deliveries in India between 2016 and 2021 – An analysis of Tamil Nadu and Chhattisgarh. *BMC Pregnancy and Childbirth*, 23(622). https://doi.org/10.1186/s12884-023-05928-4
Urana, M., & Dongre, A. (2020). Too much care: Private healthcare sector and caesarean sections in India. *Economic and Political Weekly*, 55(35).
Gilliam, M., Rosenberg, D., & Davis, F. (2002). The likelihood of placenta previa with a greater number of cesarean deliveries and higher parity. Obstetrics & Gynecology, 99(6), 976-980.
Matevosyan, N. R. (2015). The overuse of cesarean section: Medical, legal, research, and economical pitfalls. *Journal of the Knowledge Economy*, 6(4), 1090–1103.
Bhatia, M., Dwivedi, L. K., Banerjee, K., & Dixit, P. (2020). An epidemic of avoidable caesarean deliveries in the private sector in India: Is physician-induced demand at play? *Social Science & Medicine*, 265, 113452.
Rahman, M., Khan, N., Rahman, A., et al. (2022). Long-term effects of caesarean delivery on health and behavioural outcomes of the mother and child in Bangladesh. *Journal of Health, Population and Nutrition*, 41(45). https://doi.org/10.1186/s41043-022-00326-6
Chandra, J., & Sen, S. (2021). One in two women undergoes C-section in private hospitals, shows NFHS data. *The Hindu*. Retrieved from https://www.thehindu.com/news/national/one-in-two-women-undergoes-c-section-in-private-hospitals-shows-nfhs-data/article37715642.ece
Thevar, S. (2022). C-sections continue to rise in Maharashtra private hospitals. *Times of India*. Retrieved from https://timesofindia.indiatimes.com/city/pune/c-sections-continue-to-rise-in-maharashtra-private-hospitals/articleshow/95087896.cms
Rouse, D. J., MacPherson, C., Landon, M., Varner, M. W., Leveno, K. J., Moawad, A. H., ... & Mercer, B. M. (2006). Blood transfusion and cesarean delivery. Obstetrics & Gynecology, 108(4), 891-897.
Visconti, F., Quaresima, P., Rania, E., Palumbo, A. R., Micieli, M., Zullo, F., ... & Di Carlo, C. (2020). Difficult caesarean section: A literature review. European Journal of Obstetrics & Gynecology and Reproductive Biology, 246, 72-78.
Betran, A. P., Ye, J., Moller, A. B., Souza, J. P., & Zhang, J. (2021). Trends and projections of caesarean section rates: global and regional estimates. BMJ global health, 6(6), e005671.
Sorrentino, F., Greco, F., Palieri, T., Vasciaveo, L., Stabile, G., Carlucci, S., ... & Nappi, L. (2022). Caesarean section on maternal request-ethical and juridic issues: a narrative review. Medicina, 58(9), 1255.
Igwemadu, G. T., Eleje, G. U., Eno, E. E., Akunaeziri, U. A., Afolabi, F. A., Alao, A. I., & Ochima, O. (2022). Single-dose versus multiple-dose antibiotics prophylaxis for preventing caesarean section postpartum infections: A randomized controlled trial. Women's Health, 18, 17455057221101071.
Larsson, C., Djuvfelt, E., Lindam, A., Tunón, K., & Nordin, P. (2021). Surgical complications after caesarean section: A population-based cohort study. PLoS One, 16(10), e0258222.
Costa-Ramón, A., Kortelainen, M., Rodríguez-González, A., & Sääksvuori, L. (2022). The long-run effects of cesarean sections. Journal of Human Resources, 57(6), 2048-2085.
Yeganegi, M., Bahrami, R., Azizi, S., Marzbanrad, Z., Hajizadeh, N., Mirjalili, S. R., ... & Neamatzadeh, H. (2024). Caesarean section and respiratory system disorders in newborns. European Journal of Obstetrics & Gynecology and Reproductive Biology: X, 100336.
Wilson, B. C., Butler, É. M., Grigg, C. P., Derraik, J. G., Chiavaroli, V., Walker, N., ... & Cutfield, W. S. (2021). Oral administration of maternal vaginal microbes at birth to restore gut microbiome development in infants born by caesarean section: A pilot randomised placebo-controlled trial. EBioMedicine, 69.
Landon, M. B. (2024). Vaginal birth after cesarean delivery. Queenan's Management of High‐Risk Pregnancy: An Evidence‐Based Approach, 415-424.
Antoine, C., & Young, B. K. (2021). Cesarean section one hundred years 1920–2020: the Good, the Bad and the Ugly. Journal of perinatal Medicine, 49(1), 5-16.
M Abdel-Rahman, W., Mansour Ibrahim, S., & M Nabil Aboushady, R. (2023). Exploring the Lived Experience of Women with Vaginal Delivery after Cesarean (VBAC): A Phenomenological Study. Egyptian Journal of Health Care, 14(3), 155-166.
Nderitu, L. N. (2022). Factors Associated with an Increase in Caesarean Section Births in Kenya: Evidence from 2014 Kenya Demographic Health Surveys (Doctoral dissertation, University of Nairobi).
Mostafayi, M., Imani, B., Zandi, S., & Rabie, S. (2020). Comparing Early Postoperative Maternal Complications in Elective and Emergency Cesarean Sections. Journal of Midwifery & Reproductive Health, 8(3).
Blake, J. A., Gardner, M., Najman, J., & Scott, J. G. (2021). The association of birth by caesarean section and cognitive outcomes in offspring: a systematic review. Social Psychiatry and Psychiatric Epidemiology, 56, 533-545.
Pavlidou, E., Antasouras, G., Papadopoulou, S. K., Alexatou, O., Papandreou, D., Mentzelou, M., ... & Giaginis, C. (2023). Association of maternal risk factors with the prevalence of caesarean section deliveries: a cross-sectional study. Medical Sciences, 11(4), 66.
Ahmmed, F., Manik, M. M. R., & Hossain, M. J. (2021). Caesarian section (CS) delivery in Bangladesh: A nationally representative cross-sectional study. PloS one, 16(7), e0254777.
Papadopoulou, S. K., Mentzelou, M., Pavlidou, E., Vasios, G. K., Spanoudaki, M., Antasouras, G., ... & Giaginis, C. (2023). Caesarean section delivery is associated with childhood overweight and obesity, low childbirth weight and postnatal complications: a cross-sectional study. Medicina, 59(4), 664.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Shilpa Jadhav, Rituja Shram
This work is licensed under a Creative Commons Attribution 4.0 International License.
You are free to:
- Share — copy and redistribute the material in any medium or format
- Adapt — remix, transform, and build upon the material for any purpose, even commercially.
Terms:
- Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
