Descriptive study – assessing the factors contributing to caesarean delivery on maternal request in the Sri Lankan setting

Introduction: The caesarean delivery (CD) rate in Sri Lanka increased steadily to 43.1% in 20231, with cesarean delivery on maternal request (CDMR) being a significant factor. This study aims to identify the factors contributing to CDMR in Sri Lanka.Materials and Methods: The study was conducted at Sri Jayewardenepura General Hospital, a semi-government hospital in Sri Lanka. Data were collected prospectively from October 1, 2021, to July 30, 2022, in both general and paying wards. Pregnant women admitted for elective delivery who requested a CD without medical indications were included in the study. A total of 115 participants were selected for the study using a simple sampling method. Data was collected through a selfadministered questionnaire. Ethical approval was obtained from the relevant authorities.Results: A total of 115 cases were analysed. The leading reasons for the requesting CD include fear of pain 20 (17.4%), history of subfertility 16 (13.9%), fear of tears/episiotomy 14 (12.1%), due to underlining medical conditions which are not contraindicated for VD 13 (11.3%), vaginismus 10 (8.6%), simultaneous female sterilisation 7 (6.1%), having a health insurance 7 (6.1%), time the delivery 6 (5.2%) and advance maternal age 5 (4.3%). The reasons for cesarean delivery on CDMR were also different based on parity.Conclusion: Limited knowledge about normal labour, pain management options, perineal care, and long-acting reversible contraception is a key factor in MRCD. Socioeconomic factors and insurance policies also play a role in CDMR decisionmaking.