Factors associated with normal childbirth in Bangladesh: insights from BDHS 2022

The mode of childbirth has severe consequences on maternal and neonatal outcomes. Although the number of cesarean births has grown all over the world, the reasons that make normal vaginal delivery (NVD) a good choice in Bangladesh are under-researched. This research paper analyzes socio-demographic, obstetric, and medical factors that influence NVD to develop specific interventions that can lead to safer and more physiological deliveries. Data were extracted using 5,006(weighted) ever-married women aged between 15–49 years with live birth within 2 years before the Bangladesh Demographic and Health Survey (BDHS) 2022. Bivariate screening was done using Rao-Scott adjusted chi-square tests, and multivariable binary logistic regression was also done to estimate adjusted odds ratios (AORs) with 95% confidence interval (CI). The Hosmer–Lemeshow test and the variance inflation factors were used to measure the model fit and multicollinearity. Overall, 55.34% of women gave birth normally through vaginal delivery, and 44.66% gave birth through cesarean section. On adjustment, older maternal age was related to decreased odds of normal vaginal birth; women aged 25–34 (AOR = 0.77; 95% CI: 0.62–0.95) and 35–44 years (AOR = 0.53; 95% CI: 0.35–0.79) had lower odds than women aged 15–24 years. Women in Chittagong (AOR = 2.42; 95% CI: 1.63–3.59) and Sylhet (AOR = 2.26; 95% CI: 1.39–3.65) had significantly higher odds of normal vaginal delivery than women in Barisal. Women who were employed were more likely to deliver normally than unemployed women (AOR = 0.77; 95% CI: 0.63–0.94). On the other hand, women in the top wealth quintile (AOR = 0.52, 95% CI: 0.32–0.86) and those with two or more visits to antenatal care were found to have much lower odds of normal vaginal birth. The facility-based delivery was mainly linked to cesarean section. Normal vaginal birth in Bangladesh is associated with younger age, certain areas, employment, poverty, reduced ANC usage, and home births. Emerging requirement: evidence-based facility practice and equity to reduce the unnecessary cesareans.